Individual Medical Insurance &The Affordable Care Act

The Affordable Care Act, also known as Obamacare, has significantly changed the Health Insurance market. the individual market saw the vast majority of the changes due to the original implementation of the law and has since continued to change as insurers have to find ways to survive in the unfriendly market.

If you do not have coverage under an ACA compliant plan, you are subject to the Individual Mandate Penalty, collected on your taxes. The penalty is currently the greater of $695 or 2.5% of the household income for every adult in the household without coverage and half of that amount for every child under 18 (1/12th of the penalty is assessed for each month without coverage). This Individual Mandate and Penalty are scheduled to go away in 2019.

Individual insurance is still available and are still Guaranteed Issued! There is at least one carrier in every county in Texas, though many counties may only have one carrier to choose from. Plans can be bought through your agent directly from the carrier or through the Individual Marketplace (or exchange). Any plan bought from is a Marketplace plan, though you can also purchase on exchange plans directly from the carrier. If you want us to be your agent on your plan, please follow the instructions and links in the Medical Enrollment section below.

In order to purchase an Individual Health Insurance plan, you must sign up during the Open Enrollment Period or during a Special Enrollment Period.

Open Enrollment is the time of year that you can switch plans or sign up for new coverage. This Enrollment Period can change from year to year. For plan year 2017, Open Enrollment runs from November 2016 through January 31st, 2017.

Special Enrollment Periods are 60 days before or after a qualifying event. Qualifying events are when an individual has a change in family status (birth, adoption, marriage, divorce, etc.), change in residence or an involuntary loss of coverage.

If you choose to purchase a plan on the Marketplace, you may qualify for a Premium Tax Credit to lower the cost of monthly premium if you fall in the household income level of 133%-400% of the federal poverty level.

If you have missed Open Enrollment and do not have a qualifying event, your next option is Temporary Health Insurance. These plans are limited to 3 months of coverage but may be the thing you need to get you to the next Open Enrollment. These plans are medically underwritten, and are therefore not an ACA compliant plan, but can cost significantly less than other plans.

Medical Enrollment

For ACA Compliant Plans, you can run quotes and apply through the following link:

BlueCross BlueShield of Texas

For Temporary coverage, you can run quotes yourself and apply through the following link:

Individual Dental Insurance

Dental care can be just as critical to your overall health as Medical care. Dental insurance plans will help you pay in 4 main areas of care:

  1. Preventive – Traditional cleanings and x-rays
  2. . Basic Restorative – Minor procedures such as fillings
  3. Major Restorative – Larger procedures such as bridges
  4. Orthodontia – Braces

Pay attention to how each plan covers each level of care and the waiting periods for each to compare value to the cost.

Individual Vision Insurance

Your eyes can be the first thing to show signs of certain medical conditions such as glaucoma and diabetes. Vision insurance will allow special discounts and can help pay for routine eye exams and vision correcting materials.

To compare plans, compare eye visit copays, material allowance amounts and frequency of covered materials.

Individual Critical Illness

While your medical insurance helps you cover all of your medical needs, it will not help cover associated costs of a critical illness such as travel costs, lost income or other surprise bills. Critical Illness insurance will give you a flat amount of money to have in your pocket when you have had a specified medical event. So when you have a stroke, for example, you could get money for rent, bills, medical equipment, or even your deductible.

Cancer Policies

Cancer policies are Critical Illness policies meant specifically for Cancer. Cancer treatments can cost a family more than just their out of pocket costs, and these policies help protect your family’s finances in a rough situation.

Life Insurance

Life insurance is a protection for those you leave behind when you can’t be there for them anymore. Protect their home, belongings and lifestyle tomorrow with a policy today.

Life insurance comes two ways:

  1. Permanent Insurance – Whole life or Universal life policies allow you to keep coverage till very late in your life and will not be repriced in the case of a health condition.
  2. Term Insurance – Life insurance can be purchased for a specified amount of time, where the price will not be changed once it is issued. The limited life of the policy makes Term Insurance a very affordable way to provide necessary coverage.

We help you determine the insurance type and amount you need and discuss the best ways to customize your coverage for your situation.