Healthcare Options
Losing health coverage? Here is help!
Health insurance is complex, but knowing your options doesn’t have to be. Not everything is expensive. There isn’t just one option for everyone to consider, either. There are multiple ways to access the healthcare system and to be protected by either an insurance policy or by like-minded peers in a cost-sharing organization.
Prosperity Benefits, LLC is a health insurance brokerage that works with companies and individuals alike to create the most affordable and innovative packages available in the market. Many of the vendors with whom we work are located across the country, and they were found by networking with hundreds of professionals in the sector and attending national conferences. As a Health Rosetta Accredited Advisor, Niko Caparisos is obsessed with transparency and next-level solutions. This page exists to help people that are losing their healthcare coverage. In full disclosure, the agency earns commissions or fees that are included in the quoted amounts through the links. In an opaque industry where it is hard to find answers, Prosperity Benefits is here for you!
Learn about your coverage options, when you can sign up, how long you have to sign up, and whether or not you even have to. You can click through the links below to become insured or join a cost-sharing community.
COBRA
If you worked for an employer that had more than 20 full-time equivalent employees for the last 180 days, then you should be offered COBRA as an option if you were covered by the plans. COBRA may or may not be attractive, but there are a few things to keep in mind. You will be responsible for up to 102% of the total premium and your employer’s contribution will be reduced to $0. For this reason, it may be more expensive than other alternatives.
Qualifying Life Event
Full list here: https://www.healthcare.gov/glossary/qualifying-life-event/ Know when you can make changes to your enrollment.
Special Enrollment Period
Know how long you have to act: https://www.healthcare.gov/glossary/special-enrollment-period/ Generally, acting quickly helps you as the member. You are not allowed to have a gap in coverage if you are purchasing a traditional insurance plan after losing another.
Fines
Individuals no longer face financial penalty by way of fines, however, it is always wise to have some degree of protection or insurance. Self-pay may seem like a great idea, but self-paying for an unexpected injury or illness may lead to forced medical bankruptcy. Learn more here: https://www.healthcare.gov/fees/fee-for-not-being-covered/
Short-Term medical
This is an insurance product designed to bridge a coverage gap or as a longer term solution, depending on the individual. This is underwritten, meaning that for an application to be approved an applicant must truthfully answer ‘no’ to all of the health questions on the application. They may be catastrophic in nature, but this allows for very low premiums for the members. Some plans can be written in 36 month periods. It is important to note that losing short-term medical insurance is NOT a qualified life event and if you fall ill while having this coverage, you may not be able to purchase it again. For this reason, it is wise to purchase a plan that expires on 12/31 which would allow you to opt into the regular insurance marketplace, or a plan that lasts up to 36 months. You can terminate the plan at any time. Purchasing for 36 months means you can cancel it and get a more robust policy any January 1st or if you find a job with group benefits for which you are eligible to participate.
Option 1:
Coverage Up to 3 Years: IHC
Option 2:
Cost-Sharing
If you live a healthy lifestyle and have the desire to pay as little as possible for as much protection as you can afford, then medical cost-sharing may be for you. We represent Sedera, which is the largest non faith-based community of all the cost-sharing programs. This is not insurance, rather a group of people that share in medical needs as they arise. You can choose between several levels of initial “unshareable” amounts and costs vary between the tiers. If you have a Direct Primary Care doctor, you pay less for your monthly contributions. Please be sure to learn about this option through the links below.
If you do NOT have a Direct Primary Care doctor, please use this link:
Individuals: http://www.joinsedera.com/NikoCaparisos
If you DO have an active membership and can produce a receipt, then you qualify for lower payments.
Traditional Health Insurance
IF you believe you qualify for a subsidy, you should navigate to www.healthcare.gov, register, and sign up online.
If you do NOT believe you qualify, then you can use this link to learn about options and sign up. The technology helps you choose the best plan for your individual scenario.
Prescription Savings Card
Pharmacy is complex and depending upon your health plan’s pharmacy benefit administrator contract reads, it may or may not provide the best pricing for your prescriptions. It pays to do research.
You may ask the pharmacy to run your CleverRX card instead of your insurance if you already know it is cheaper to use the alternate program. You can ask your pharmacist what the cash price is or what discounts they have.
Get your CleverRX Card here!
Other Useful Resources
Direct Primary Care Options
Having a relationship with a primary care physician is important and it is always best to find one in your local market. If you prefer a tech-based solution, several exist:
Finding Cash Prices
You can pay cash for medical care, if you need to, and again, it may be available at a lower cost out of your pocket depending upon your insurance network and their negotiated discount with facilities and providers. Become a healthcare consumer and use these resources to prospectively learn pricing before a planned medical event takes place.