INDIVIDUAL AND FAMILY COVERAGE
The Health Insurance Shoppe offers individuals and families coverage options through -
Marketplace Health Plans
Short Term Medical Plans
Health insurance is a very complex product and The Health Insurance Shoppe is here to simplify the complexity of your available options. Please scroll down to learn more about each product.
MARKETPLACE HEALTH PLANS
The Health Insurance Shoppe represents the above insurance carriers for The Health Insurance Marketplace (Marketplace), which are plans that cover essential health benefits and pre-existing medical conditions. All carriers offer their plans on the Marketplace as well as offering direct enrollment through the insurance carrier which takes the Marketplace out of the equation when there's not eligibility for a premium tax credit.
Essential health benefits include Preventative Care (adult and children) that is covered at 100%, Mental Health and Substance Abuse Coverage, Maternity Services, Fertility Treatment, and do not have annual or lifetime benefit maximums.
Enrollment in a Marketplace plan is allowed during the Annual Enrollment Period (AEP) that occurs between 11/1/2021-1/15/2022 to acquire coverage for the following year. Outside of the AEP individuals can enroll in a Marketplace plan if there ;s eligibility for a Special Enrollment Period (SEP) within the past 60 days or next 60 days.
There are no fees associated with learning about your options. The Health Insurance Shoppe can assist with your enrollment on the Marketplace or with your direct carrier enrollment when there is not qualification for an Advanced Premium Tax Credit (APTC) through the Marketplace.
To receive a proposal on your options we ask for you to call The Shoppe, schedule an appointment, or to complete the below proposal request.
SHORT TERM MEDICAL PLANS
Short Term Medical plans are "temporary" plans of coverage that can be acquired for up to a maximum of 180 days before the policy expires. These type of plans are not considered a "Qualified Health Plan" and do not include all of the essential health benefits that are required under The Affordable Care Act (ACA). Coverage is not guaranteed and most importantly, Short Term Medical plans do not cover pre-existing medical conditions.
To learn more about your Short Term Medical plan options please call The Shoppe or you are can start a personalized quote below.
Although Health Insurance is there to protect you against unforeseen accidents and illness -- you are still exposed to deductibles, out-of-pocket maximums, copayments, as well as services that may not be covered by your plan. Acquiring an Indemnity Plan of coverage can help you with out-of-pocket costs when faced with large claims. The Health Insurance Shoppe can offer you a Indemnity Plan that fits your needs and we invite you to learn more about the products offered from UnitedHealthCare.
FAQ's regarding QHP's
When is the Annual Enrollment Period (AEP)?
The Annual Enrollment Period runs between 11/1-12/15 of each year to enroll in a Qualified Health Plan (QHP) that takes effect on the first day of January in the coming year.
Am I allowed to acquire coverage outside of the AEP?
The only way to acquire a Qualified Health Plan (QHP) outside of the AEP is if you are experiencing a Qualifying Life Event. You do have the option to enroll in a "Short Term" medical plan, which is not considered a QHP and are medically underwritten, and can enroll in this line of coverage for up to 90 days at a time.
What is The Health Insurance Marketplace and why should I use it?
The Health Insurance Marketplace (Marketplace) is a online enrollment portal for enrolling in coverage with health insurance carriers that offer products on the Marketplace. The same products can be acquired directly with the insurance carrier at the same premium, however, should your household income qualify for assistance (reduced premiums), than the only way to receive the assistance is by acquiring coverage via the Marketplace and not through the carrier directly.
Qualification for assistance, which is in the form of an Advanced Premium Tax Credit (APTC), is based on your 2021 Projected Household Modified Adjusted Gross Income and if it falls between 133%-400% of the Federal Poverty Level (FPL). Effective 4/1/21, individuals or families with income above 400% of the FPL will now qualify for an APTC that reduces the cost of the second lowest Silver plan to 8.5% of their household income.
Do the available insurance carriers within The Health Insurance Marketplace offer different plans outside the marketplace?
The answer can be "yes" and "no" depending on why the question is being asked. If asking because the plans available on The Health Insurance Marketplace do not include your preferred doctors and hospitals, and are wanting access to a larger PPO that includes your preferred doctor and hospital...the answer is no. The insurance carriers offer the same provider networks when coverage is being acquired outside of The Health Insurance Marketplace, and enrolling directly with the carrier (Cigna excluded) you are taking the The Health Insurance Marketplace out of the picture.
If you are not eligible for an Advanced Premium Tax Credit via The Health Insurance Marketplace and are looking for different plan benefits than what are offered on The Health Insurance Marketplace...than the answer is yes. Blue Cross and Blue Shield of Illinois (BCBSIL) offers a Silver plan that is only available direct and offers a Gold plan that is only available directly to consumers who are exhausting their COBRA coverage.