Basics
What is private health insurance?
It is medical coverage you buy directly from a carrier through a licensed agent, rather than through an employer or the ACA exchange. It is an umbrella consumer term covering several different coverage structures — medically underwritten major medical style plans, fixed indemnity, ERISA/association coverage, short-term medical and supplemental products — which are not all ACA-compliant major medical, and which is why prices vary so widely. What is private health insurance? walks through each one.
Is it the same as ACA or Obamacare coverage?
No. ACA-compliant major medical is guaranteed issue and subsidy-eligible. Medically underwritten private plans ask health questions and are priced on your own risk. Fixed indemnity, short-term and supplemental products are different again and are not comprehensive major medical.
What kinds of plans do you actually sell?
Medically underwritten plans such as Bright Life, LifeX, Manhattan Life Affordable Choice and Philadelphia American Optimum Health Saver; fixed-indemnity coverage through Medical Mutual Protect, usually paired with a catastrophic layer paying up to $1,000,000 per person per year after a $5,000 deductible; guaranteed-issue, membership-style coverage through Enrollment First SelectMed Bronze Pro; and supplemental products. We never sell short-term medical standalone. Availability varies by state, carrier and plan.
Cost
How much does private health insurance cost?
On the two plans that publish rates, a single adult runs $359 to $509 a month and a family $949 to $1,129, depending on age band and plan design. Other plans we offer require a personalized quote. Full tables, including couple and child-only rates, are on the cost page.
What drives my premium up or down?
Age band, who you are covering, your state, the deductible you choose, tobacco use and what underwriting says about your health. Income is not one of them — we never ask what you earn.
Is private cheaper than an exchange plan?
For a household getting little or no subsidy, underwritten private coverage often costs less than an unsubsidized exchange plan, because it prices on your own health rather than the whole community — though this depends on health, household, location and subsidy eligibility. If you qualify for a large premium tax credit or a cost-sharing reduction, the exchange is usually the better deal, and we will tell you so.
Are dental and vision included?
No. Dental and vision are separate supplemental products, quoted separately.
Eligibility and health questions
Can I be turned down?
Yes. Underwritten plans ask health questions and can issue at a standard rate, charge more, exclude a specific condition, or decline. Nobody can promise you acceptance. See eligibility.
What if I have a pre-existing condition?
It may be excluded, rated or grounds for a decline, depending on what it is and how recent the treatment was. If underwriting rules you out, one guaranteed-issue option exists where nobody is declined — Enrollment First SelectMed Bronze Pro, which is membership-style coverage rather than major medical — and ACA exchange plans cannot decline you at all.
I am already pregnant. Can I buy a private plan for it?
Generally no. Underwritten plans treat an existing pregnancy as a pre-existing condition. Maternity availability otherwise varies by plan and state; some underwritten plans cover it only if you enroll before pregnancy — ask an agent. The honest detail is on the family page.
Networks and doctors
Can I keep my own doctor?
Many providers participate, because our PPO plans use national networks including PHCS, First Health, Aetna, Cigna and Blue Cross Blue Shield BlueCard. Network size and access depend on the plan and your area, so check a specific doctor and hospital in the plan's directory before you apply.
What is the difference between a PPO and an EPO or HMO?
A PPO gives you out-of-network coverage at a higher cost share. EPO and HMO designs give you much less room outside the network, which is how they price lower. PPO vs HMO explains the trade-off.
Are private networks bigger than ACA networks?
Often, because many exchange plans use narrow local networks while many of our plans use national PPOs. It depends on your county, the plan and the carrier, so compare the actual directories. See private PPO vs ACA networks.
Enrolling and timing
Can I apply outside open enrollment?
Generally yes. Private medically underwritten coverage has no annual enrollment window, so you can apply in any month, subject to underwriting. Exchange plans require open enrollment or a qualifying life event.
I just lost my job. What is the fastest route?
Losing employer coverage is a qualifying life event that opens a special enrollment period on the exchange, and there is a deadline on it. A private plan can also start in a month you choose. Compare both — the detail is on health insurance without employer coverage.
How do I enroll?
A licensed USA Benefits Group agent with AO American Benefits writes every application; consumers do not enroll themselves online. You can research and compare plans first without giving any contact details.
Comparing with ACA coverage
Which is better for me?
It depends on health, household, location, eligibility and what is available in your state. A household qualifying for a large subsidy or a cost-sharing reduction is usually better off on the exchange. Private coverage tends to win for healthy households getting little or no subsidy.
Will you tell me if the exchange is my better option?
Yes. That is the point of the site. The comparison is laid out in full on private health vs the ACA marketplace.
Do you need my income to work this out?
No, and we never ask. There is no income or MAGI question anywhere on this site. Subsidy eligibility is something you can check yourself on the exchange.
Claims and using the plan
How do claims work?
On a network plan, your provider bills the plan directly and you pay your share. On a fixed-indemnity plan the benefit is a set dollar amount for a covered service, which may be less than the bill — that is exactly why we pair indemnity with a catastrophic layer. How private health insurance works covers the mechanics.
What is a gap plan for?
It sits under a high deductible and helps with the amount you would otherwise pay first. Pre-Med Defender GAP covers sickness as well as accident, which is not true of every gap product on the market.
Where do I find the actual policy documents?
Carrier brochures are published on the resources page. Benefits, limitations and exclusions vary by state and are confirmed at application — read the documents for your state before you buy.
Working with an agent
Do I have to talk to someone to see plans and prices?
No. You can research the whole site and use the marketplace without giving a name, phone number or email. Nobody calls you because you looked at a page.
What does the agent do that I cannot do myself?
A licensed agent knows which carriers are filed in your state, how each one underwrites a given condition, and how the layers fit together — and is legally required to write the application. Availability alone rules out plans in many states before price is even discussed.
Can I deduct my premiums?
Self-employed people often can, but the rules depend on your situation. Ask your tax advisor, not your insurance agent.
What if I want to talk to a person?
Call 256-743-5362, or use the marketplace and choose a benefit consultation at the end. Either way it is your move, not ours.