Health Insurance Examples: Which Coverage Works for Various Situations

If you don’t currently have health insurance coverage, or you’re wondering about other options, it’s helpful to understand what’s available. That way, you can make a cost-effective decision that works for your finances and ensures you have the health insurance coverage you need. 

Let’s explore some ways to get health insurance coverage. We’ll use Jack and Jill Smith as an example. The couple has two kids, lives in Arizona and needs family health insurance. The following scenarios illustrate when they might choose each plan. 

1. Healthcare.gov Marketplace

How the Healthcare.gov Marketplace Works

The Healthcare.gov federal insurance Marketplace offers American citizens the ability to compare and shop for various health insurance plans online through the website. A health insurance broker can also browse plans for you, and present ones that include coverage for the doctors and terms you prefer.

These plans are primarily health maintenance organization (HMO) plans, which means only certain doctors are covered within each plan. Keep in mind, if you choose insurance through the Marketplace, it’s important to filter plans based on the ones that offer coverage for your preferred doctor(s). Otherwise, you may not be able to get health insurance coverage with your current provider when you choose various Marketplace plans.

Getting insurance through the Marketplace is generally best for people who qualify for discounts based on their income, or for those who have pre-existing conditions, as the Marketplace plans cover those.

You can use the Marketplace’s income levels and savings calculator to see if you might qualify for health insurance savings through the Marketplace. You may be able to qualify for a premium tax credit that lowers the monthly premium.

When a Healthcare.gov Marketplace Plan Makes Sense

One reason Jack and Jill would look into a Marketplace health insurance plan is when Jack has a recurring back issue and sees the doctor regularly. Because of his pre-existing condition, he might work with a health insurance broker to look into a Marketplace plan that covers his existing back issues.

Another scenario where the couple might consider a Marketplace plan is when they have a relatively low income. Let’s say their combined household income is $60,000 per year. Based on that income, they may qualify for a government subsidy when obtaining health insurance. It may be the most cost-effective for the couple to choose a Marketplace plan, based on the subsidy they can get.

2. Private Health Insurance Plan

How the Private Health Insurance Works

With private health insurance, like that offered through Arizona Health Insurance Brokers, a person seeking health insurance contacts a health insurance broker to facilitate health insurance coverage for them. The health insurance broker works on behalf of a health insurance company or companies, and helps individuals and families navigate various health insurance choices to choose the best plan.

Private health insurance provides flexibility, as you can compare more options and customize a plan based on your needs with the expert help of a broker. Sometimes, private insurance plans offer lower prices compared to Marketplace policies, especially for people who are relatively healthy and who don’t qualify for Marketplace discounts based on their income.

Private health insurance provides a convenient way to get health insurance coverage, especially when you don’t have options through your employer. As the number of full-time independent workers in the U.S. has drastically increased in the past 6 years, private health insurance also helps solopreneurs and independent contractors get health insurance coverage when they’re their own boss.

When Private Health Insurance Makes Sense

Let’s say Jack and Jill are both relatively healthy, but their household income is too high to qualify for Marketplace subsidies. They research their Marketplace options, but after talking to a private health insurance broker, they learn a private plan is cheaper and more flexible. 

Going with a private health insurance plan makes sense in this scenario, since it offers cost-effective health insurance coverage for their family. 

3. COBRA Health Insurance Plan

How COBRA Health Insurance Works

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. When someone loses their job, that individual (and potentially their family members) can continue receiving the group healthcare benefits they previously had at their former job. COBRA offers continued healthcare coverage for limited periods of time for circumstances including:

• Involuntary or voluntary job loss
• Reduced work hours
• Transition between jobs
• Death
• Divorce

If you or a loved one has gone through significant life events that impact health insurance coverage, like those above, you may qualify for COBRA coverage to continue your healthcare plan, uninterrupted.

COBRA health insurance may make sense depending on factors like cost and how much an individual/family has paid into a deductible. Because COBRA health insurance coverage can be more expensive than a plan through a private insurance broker, it may make sense only in certain situations, including:

• Someone is taking expensive medication that was covered in a former group plan.
• Someone needs to see specific doctors who aren’t in-network with other insurance plans.
• Someone has specific health issues and has already met their health insurance deductible.

In some instances, when someone has been a part of a large group health insurance plan, the cost of COBRA is similar to what Marketplace or private health insurance quotes would be. Before choosing COBRA coverage, you can speak with a health insurance broker to see if you could save money with a different plan, or if it makes sense to choose COBRA coverage. 

When COBRA Health Insurance Makes Sense

Using Jack and Jill as an example, let’s say Jack has switched jobs. Jill recently had surgery, so the couple has already met their deductible. Jill has surgery follow-up appointments with several doctors she prefers.

In this case, it may make sense for Jack and Jill to choose a COBRA plan. This way, Jill can see the doctors she prefers, and the plan could potentially be a cost-effective option, since the couple has already met their deductible.

4. Group Health Insurance Plan

How Group Health Insurance Works

Group health insurance refers to health insurance coverage offered through a business. When someone works for a company, the business may offer health insurance coverage. Business owners can look into offering group health insurance to their employees, as a way to attract talent and increase retention among their staff.

Group health insurance can be a convenient option for professionals, as coverage may also extend to a spouse and dependents. You can get coverage when you start working at a place group insurance is offered, but if you leave your job, you’ll need to explore COBRA coverage or another health insurance option for coverage.

When Group Health Insurance Makes Sense

For Jack and Jill, they may be interested in group health insurance plans if they’re offered by their employer(s). If one person works for a company and the other person works from home, there may be options to get health insurance coverage for the entire family through a group health insurance plan. 

Jack and Jill can compare pricing and coverage with other types of plans before they decide to sign up for group health insurance. In some cases, private health insurance may be the less expensive and more comprehensive option. 

If Jack and Jill own their own business, it may make sense for them to secure group health insurance coverage for themselves and their employees. There are diverse health insurance plans business owners can choose from, including health reimbursement arrangements (HRA) like an individual coverage health reimbursement arrangement (ICHRA) and a qualified small employer health reimbursement arrangement (QSEHRA). Business owners can also look into health savings account (HSA) arrangements for their workers.

Get Help Comparing Health Insurance Plans 

There are lots of ways to get health insurance coverage so you and your loved ones are protected when medical issues arise. Health insurance coverage can help you save money when you get annual check-ups and need treatment for whatever happens.

At AZ Health Insurance Brokers, we can help you compare private plan coverage, get group health insurance coverage for a business or explore other health insurance options. We’re here to help you learn about what’s available, so you can make the most cost-effective decision for yourself and your family.

Set up a free consultation online, give us a call at 602.617.4107 or email quotes@azhealthinsurancebrokers.com. We’ll be in touch to help you walk through your options.