Health Insurance

Individual and Family Health Insurance

Our team of health insurance experts can help guide your spouse in selecting a health insurance plan until they reach Medicare eligibility.

Health Insurance Advice and Recommendations

We generally only offer guidance for individual health insurance for the spouses of our Medicare clients who haven't reached Medicare yet. We currently do not assist with applying for health insurance through Kynect or Healthcare.gov but can guide the non-Medicare spouses of our Medicare clients to understand their health insurance options until age 65. We also know another knowledgeable, independent local professional that we can refer you to for coverage. Plans are usually applied for and managed through a marketplace exchange. These can be run by the state (like KY's Kynect) or through the federal marketplace (healthcare.gov).

The Affordable Care Act Explained

The Affordable Care Act has changed the way we purchase and benefit from health insurance. There are no pre-existing condition exclusions or underwriting questions, except for tobacco use. This means no one can be denied a plan or be rated-up due to health conditions. Enrollments and plan changes are limited to once per year unless you are eligible for a Special Enrollment Period (like moving out of state, losing other coverage like birth, death, marriage, divorce etc). The Open Enrollment Period is November 1st to January 15th and is the only time you can get health insurance if you don't have it, or to make a change to a different plan if you already have a plan.

The Affordable Care Act (ACA) no longer requires that all citizens have health insurance and there is not a tax penalty for not having insurance (these rules ceased in 2018). The ACA requires all plans to include 10 Essential Health Benefits, chosen by the federal government. This makes buying insurance easier because all plans must cover at least the same core benefits.

Based on your household composition and income in relation to certain benchmarks in the Federal Poverty Level, you may be eligible for premium subsidies (Advanced Premium Tax Credits/APTC) or cost subsidies (cost-sharing reduction/CSR). These subsidies can make your costs more affordable. There are other factors that are considered when your subsidy is calculated. Since subsidies are tax credits, you must file a tax return every year and reconcile your subsidies with your actual income using the 1095-A form. Failure to do so could result in tax obligations and loss of your subsidies moving forward.

HMO vs PPO

Most of the plans on the healthcare exchanges are HMO's. A Health Maintenance Organization (HMO) means that you MUST see doctors in the network, or you will pay 100% of the cost and have no coverage. It is critical that you only see doctors and facilities that are in-network. A Preferred Provider Organization (PPO) means that you can see doctors out of the network and have coverage, but your costs are higher than if you see in-network doctors.

Drug Coverage

Since all plans must include prescription drug coverage, you also need to check that your medicines are on the formulary and understand how the plan you are considering covers the medicines you need. Does it have a separate drug deductible? How does the plan tier your medicine and what are the copays for each tier? Consider all your routine and fixed costs when selecting a health plan because the premium is not the only important factor in making a good choice for yourself.

Help From An Experience Health Insurance Agent

While we can help the non-Medicare spouses of our Medicare clients navigate this process, we currently do not help with Kynect or Healthcare.gov applications or plan enrollment. We respect how important this insurance is to you and have met with many other local professionals to find a trusted agent that can help you. Please reach out to us for the name and number of the knowledgeable, experienced Louisville-local agent we refer our clients to.

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