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  • lisaannettestanley

Individual Health Plans

Open Enrollment for Self Employed, 1099, part-time employees & those who are otherwise ineligible for employee benefits for individual health coverage for Obamacare begins 11/1.

As an Agent, I got into this industry 11 years ago out of a genuine interest in helping myself by helping others, going places others would not go: the Low-Income charity cases, working in the HIV/AIDS free clinic, etc. I haven't found much caring among Medicare providers - & now this nightmare of mega-mergers. It's a terrible time to try to make a living in the Insurance Industry.

There's got to be a better way to support myself out there.

That having been said, Individual Health Plans are an ENTIRELY DIFFERENT aspect of health coverage that is neither Medicare nor Employee benefits.

In general, the 3 main types of Health Insurance are

  1. Government Sponsored (Medicare, Medicaid, CHIP)

  2. Employer Sponsored Employee Benefits (including both Major Medical & Supplements)

  3. Individual Coverage (both Individual through private Insurance Companies & government-sponsored, like the ACA under Obamacare.)

Each of these types of coverage have their unique qualities that require Continuing Education on the part of agents as they can differ wildly from Plan to Plan & State to State and Year to Year.

Even in a good year, plans change on an annual basis which is why coverage is only for a 12 month period & must be renewed every year.

Although I am an Agent, as a Self-Employed customer of a federally-subsidized plan, finding providers who actually accept my plan is the biggest challenge I face. (I may be an Agent, but what people don’t realize is that NOBODY COVERS ME - I need to cover myself.)

I still find my personal health coverage an exercise in frustration.

I can get the simplicity of the four-plan structure: Bronze, Silver, Gold & Platinum, but once we get into the practical application of USING the coverage the main struggle I am having is with respect to LACK OF NETWORK PROVIDERS.

The plan offerings for next year for my situation are no better than the plan I already have, except that to keep my same coverage is substantially less in monthly premium for the same frustrating lack of providers.

It occurred to me that even if I stay with the same Insurance Provider that at the very least I would buy a PPO (with Out of Network benefits) instead of the HMO (Network Providers only) that I currently have. There are NO Silver PPOs offered by my current company.

I logged on first thing this morning to get ready for tomorrow & my teeth are still on the floor. My plan DOES pay wonderfully, but my network is primarily the charity hospitals of the Harris County Hospital System: LBJ & Ben Taub.

The County Hospitals are driven by REFFERAL by a SPECIALIST. Not all Specialists in the system take the plans: it is up to the individual doctors whether or not to accept the coverage of any particular plan.

OMG - take a number & die waiting for an appointment IF I can find an In-Network Provider. :(

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