Individual and Family
Arch is one of the largest individual health insurance brokerages in the area. We have had as many as 1,000 individual policies in place in the past, and have served the area for nearly 50 years.
We can help most people find a medical insurance plan that fits their budget, from a plan that offers generous coverage to a high-deductible plan designed primarily to protect your family from the cost of catastrophic illness. These plans will meet the requirements of the Affordable Care Act health care reform law, so you will not have to pay a penalty.
You can also buy supplemental insurance plans that will pay some of the costs your health insurance plan won’t cover. These include hospitalization insurance (or hospital indemnity insurance), critical illness insurance and cancer insurance. These supplemental insurance plans will pay benefits that you can use however you choose if you are hospitalized or suffer a covered illness.
What are my options for health insurance?
Best Option: Grandfathered & Grandmothered Plans
If you have a plan you can keep, KEEP IT! This is only applicable to those on Grandfathered plans, or those that have Anthem BCBC Grandmothered plans. The pullout of Anthem from the ACA plans does not impact the pre-ACA plans.
Next Best: Group Options
For those that have access to group coverage, or have business interests that would allow them to put together group plans (at least 2 employees), we recommend you go to these markets. While the small group ACA market has its share of instability, it offers much more stability and choice than the individual markets do.
If the above options do not apply, you have two choices:
ACA plans are only available through the Federal marketplace. This is the best choice for those without access to the above options, and those that have significant medical issues (pre-existing conditions). This is also the best option for those that are eligible for significant subsidy amounts as this is the only way to utilize the Federal tax subsidies to purchase medical plans.
Non-ACA plans fall into three broad categories that address individual needs such as price range, levels of coverage, enrollment periods, pre-existing conditions, and defined benefits such as prescriptions and hospitalization, among others.
What are the types of full coverage plans?
Preferred Provider Organization
PPOs are the most common type of health plan today. A PPO contracts with a network of doctors; plans typically reimburse a higher percentage of fees for in-network doctors. Members can use non-network providers but will have higher copayments. Plans usually include features to avoid unnecessary health expenditures, such as requiring pre-authorization for elective procedures or a primary care physician’s referral for visits to specialists. Most plans also include wellness or disease management benefits designed to keep your employees healthy and control your claim costs.
Point-of-service (POS) plans
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.
Health maintenance organization (HMO) plans
An HMO requires members to use physicians within the HMO’s network; HMOs typically do not pay anything for out-of-network treatment, except in case of emergency. HMOs give your employees less flexibility in provider choice, but often cost less and involve lower out-of-pocket payments than other plans.
Health Savings Accounts
Only allowed with High Deductible Plans
If you want protection from catastrophic illness but you want to pay less in premiums you can take advantage of a high-deductible health plan linked to a health savings account. These plans offer lower premiums than a plan with full coverage. You can use the savings to build funds in a health savings account, which you can use for any tax-qualified healthcare expense.
Only individuals with an eligible high-deductible health plans and no other health insurance can have an HSA. You use account balances to pay for qualified health expenses; funds can accumulate from year to year.
Some employers fund their employees’ HSAs; employer contributions to an HSA are not considered taxable income. Contributions you make, up to the annual maximum, are tax deductible. Withdrawals used for eligible medical expenses are not taxable, and interest on your funds is also not taxable.
How do I enroll in a plan?
Enrollment methods vary depending on whether you choose an ACA plan or non-ACA plan.
Enrollment in a non-ACA plan depends on which option you choose.
Learn more about my non-ACA options