Going For Gold

Going For Gold text overlaying image of a gold medalIn the complex world of health insurance, finding the right plan can be a daunting task. Among the various options available, Gold Health Insurance Plans are an appealing choice. Offering a balance between comprehensive coverage and manageable costs. This comprehensive guide aims to provide an in-depth understanding of Gold health insurance plans. Exploring their features, advantages, considerations, and how individuals and families can make informed decisions to safeguard their health and financial well-being.

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Understanding Gold Health Insurance Plans

In addition to Bronze, Silver, and Platinum health insurance plans, Gold health insurance plans are included in the tiered structure that is usually referred to as metal-tier plans. When compared to Bronze and Silver plans, the “Gold” designation denotes a better level of coverage. These plans often provide lower out-of-pocket fees and a wider range of benefits than Bronze and Silver policies. The premiums for gold plans are often greater than those for bronze and silver policies. But the out-of-pocket expenses, which include deductibles, copayments, and coinsurance, are relatively lower. This tiered structure is intended to help with offering options to customers that are compatible with their preferences regarding both their health and their finances.

 

Gold plans, which have a greater actuarial value, provide an option that is comparable to Platinum plans for those who are looking for complete coverage. But do not want to pay the premium price tag that is associated with Platinum plans. According to the Affordable Care Act (ACA), health insurance plans that are considered to be “gold” must provide coverage for the essential health benefits. The scope of these benefits extends to a wide variety of services. Such as preventative care, prescription drugs, care for mothers and newborns, mental health services, and many more. Gold plans also stand out because they cover a greater proportion of the overall typical costs of healthcare services. Gold plans must cover 80% of covered medical expenses, leaving you just 20% to cover.

The Cost of Gold Plans

The state where you live affects how much you pay for gold health insurance. The Kaiser Family Foundation says that gold health insurance costs about $462 a year on average in all 50 states. The cost of living varies from state to state. For example, the average price of a gold plan in Illinois is $464, in Virginia it’s $839, and in Maryland it’s $296. Gold plan rates are going down quickly. Which means that the tax credit covers more of the cost of the premiums than it did in the past.

Advantages of Gold Health Plans

Lower Out-Of-Pocket Costs

When it comes to getting healthcare services, policyholders who have Gold plans have a decreased cost responsibility. Which is one of the significant advantages of these policies. Despite the fact that premiums are higher, the lower deductibles and copayments can yield in overall savings, particularly for people who require medical attention on a regular basis. It is because of this, that Gold plans are an appealing choice for individuals who place a high priority on stability in their healthcare costs. When picking an insurance plan, you should think about more than just the monthly premium. You also have to consider copays, deductibles, and your out-of-pocket maximum.

Balances Cost-Benefit Ratio

This makes gold plans excellent for individuals who want complete coverage, but do not want to go with the most expensive Platinum plans. Gold plans strike a compromise between premiums and out-of-pocket spending, making them suitable for those individuals. People who are looking for financial security without going into debt are likely to be interested in this product because of its reasonable price and comprehensive coverage.

Great For Chronic Conditions

Individuals with chronic conditions or ongoing medical needs may find Gold plans particularly appealing. The lower out-of-pocket costs can make managing chronic illnesses more affordable, encouraging regular check-ups, and necessary treatments. This aspect of Gold plans aligns with the shift towards preventive care and proactive health management.

Ideal For Families

Because gold plans cover such a large portion of care they are often suggested for families. Gold plans cover a lot of maternity and infant care, which can be helpful for families with kids, people who are pregnant, or people who want to start a family. The better actuarial value makes sure that the health care needs of a family are met without having to pay huge amounts of money out of pocket.

Predictable Costs

Gold plans offer predictable healthcare costs, which can be helpful for people who are careful with their money. Lower out-of-pocket costs help consumers better predict their costs, which makes it easier to plan for their healthcare-related financial obligations. This predictability is very helpful for people who are on a set income or who always need medical care.

Drawbacks of Gold Plans

Higher Premiums

The biggest problem with Gold health insurance plans is that their annual premiums are higher than those of Bronze and Silver plans. People who are usually healthy and don’t plan to go to the doctor very often may wonder if it’s worth paying higher premiums for coverage they might not use all the time. It’s important for people to compare the cost of their fees to how often they plan to use healthcare services.

Not The Highest Level of Coverage

Even though Gold plans have excellent coverage, they are not as good as Platinum plans, which have the best statistical value and, as a result, the best coverage. People who need a lot of medical care might find Platinum plans better, even though they cost more. It is very important for people to look at their health and figure out what amount of coverage will best meet their needs.

Other Metal Tier Plan Options

Aside from Gold, you can choose from 3 other tiers: Bronze, Silver, and Platinum. Gold falls between Silver and Platinum plans on the tiers. It’s important to note that the tiers are only separated by the amount they cover, not the quality of care you’ll receive. No matter what plan tier you choose you are entitled to receive the same quality of care as anyone else. 

Bronze

In addition to being the least expensive of all the levels premium wise, the bronze level provides a coverage split of 60/40 after the deductible has been met. Meaning you’re only responsible for 40% of covered costs. Bronze plans also come with higher deductibles. Those individuals who are looking for health care coverage for the worst-case circumstances may consider purchasing this sort of plan.

Silver

While the monthly premium for a silver level plan is more than that of a bronze level plan, the silver level plan provides additional coverage at a lesser cost. Coverage on silver plans is divided 70/30. Additionally, deductibles are typically cheaper, and if you are eligible for cost-sharing reductions, you might save even more money on your medical care. Another key factor is that cost-sharing reductions are only available to those who are at the silver level.

Platinum

In comparison to the other plans, the platinum level is the most expensive, but it offers the most comprehensive coverage for medical expenses. In addition, the cost split is 90/10, and the deductibles are the lowest possible. People who require continuing medical care and want the peace of mind that practically all of their expenses are, covered might find that a platinum plan is the most suitable option.

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Finding The Right Plan

Shop Around

It’s important to look at plans from more than one insurance company when looking into Gold health insurance. You should think about each plan’s rates, deductibles, copayments, network coverage, and any extra benefits or features it offers. Shopping around for different options lets people make smart choices based on their specific health care wants and budgets.

Consider The Plan’s Network

Plans with a gold level of health insurance have a network of providers that they work with. To make sure that medical services are easy to get, it’s important to know how big the network is and which healthcare providers are included. To avoid being surprised by out-of-network costs, people should make sure that their chosen hospitals, doctors, and specialists are in the plan’s network.

Assess Your Needs

To pick the right health insurance plan, you need to carefully consider your own or your family’s medical wants. Think about things like your age, any health problems you already have, the medical care you plan to get, and your general health. Customizing the plan to meet specific healthcare needs makes sure that your health goals are met and that coverage is thorough.

The Bottom Line

If you’re looking for a good mix between full coverage and affordable costs should consider a gold health insurance plan. When choosing health insurance, it’s very important to do a lot of research, know what your personal healthcare needs are, and think carefully about how much money you have. Even though Gold plans might not be right for everyone, they are a good option for people who want financial safety, but don’t want to pay the most for a plan. The healthcare system is always changing, so people and families need to stay up to date on their choices and reevaluate their insurance needs on a regular basis to make smart decisions about their health and finances.

 

Getting a Gold health insurance plan isn’t just a matter of saving money; it’s also a way to protect your peace of mind and make sure you can get good medical care when you need it. The EZ.Insure team is here to help you find the best plan for your needs. There are a lot of health insurance plans in your area that we can quickly look at. Your personal agent will help you sort through the different plans that are out there. Also, list all the costs that come with each one. The best part is that we offer all of these services for free! Just type your zip code into the box below or call us at 877-670-3557 to get your free instant quotes.

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Group Insurance For Furloughed & Laid Off Employees

The coronavirus pandemic has taken a toll on many small businesses, and many are now struggling to stay afloat. In order to keep going, many small business owners had no choice but to furlough or lay off employees in order to save money. If you are one of them, you might be wondering what your former employees’ health insurance options are after you let them go. Is there still a way you can offer them group insurance? You can choose whether to pay monthly health insurance premiums on behalf of your employees, but if it is not possible due to financial constraints, your employees do have other options.

Furloughed Vs. Laid Off

person carrying a box of office supplies.

Health coverage for an employee is determined by the employer’s (your) health plan. The plan indicates how many hours an active employee has to work to be eligible for health insurance. There are also rules surrounding what happens to their health insurance when they are no longer an active employee. When an employee is :

  • Laid off, their employment is terminated, even if you are considering the lay off temporary. After an employee is laid off, their health insurance plan ends on the last day of the month they were laid off.
  • Furloughed, their hours are reduced, or they might not be working at all. The difference is that they can expect to return to work again when the furlough is over, so they can continue to get health insurance coverage during the furlough period. If this is the case, the employee will either be responsible for their share of the plan’s premiums, or you, the employer, can temporarily waive employee contributions and pay all of their premium.

ERISA & Federal Income Tax Rules

In general, nothing actually prevents you from paying monthly premiums on behalf of furloughed or laid-off employees. You have the option to choose to pay monthly premiums as long as you are able to. The premium will continue to be excludable from the gross income of the employees. Be aware, though, that if the plan rules do not permit an employee to be covered, then you are in danger of:

  • Potential loss of tax-exempt status of the plan, which means both you and your employees might owe back taxes, since pre-tax qualification would be lost.
  • Your insurance company denying claims for any employees that they determine are not eligible to participate in the plan. 
  • A possible fiduciary breach under the Employee Retirement Income Security Act (ERISA) if plan assets were used to pay for benefits of non-eligible employees.

    COBRA on a piece of paper.
    Laid-off and furloughed employees qualify for COBRA insurance.

COBRA Insurance

Another option to continue coverage for your employees is the COBRA program. Both laid-off and furloughed employees qualify for a Consolidated Omnibus Budget Reconciliation Act (COBRA) plan if their group plan is terminated and you can no longer pay their premiums. COBRA can be expensive for your former employees, because if you do not contribute to their premiums, they will have to pay the full amount. 

ACA Marketplace

Last but not least, losing a job is considered a qualifying life event, so a Special Enrollment Period will open up for your former or furloughed employees after they lose their job and their coverage. This means that they will have 60 days to get a health insurance plan on the ACA Marketplace. This could be a cheaper option for your employees than COBRA.

EZ Can Help

The pandemic has actually caused some changes in the way that group health insurance works. For example, some states have issued orders requiring or encouraging insurance companies to allow employers to make changes to their eligibility requirements so they can continue to offer group insurance to furloughed or laid off employees. Some states are even allowing a grace period for premium payments. To find out if your state is one of them, speak to an EZ agent, who can help find out the information for you. If you are interested in continuing to offer a group insurance plan, we can help you find a reasonable way to provide insurance to the employees that you had to let go. The times we are living in are not normal by any means, and we know it is not an easy decision to let go of your valued employees. EZ can help by offering our services for free, which includes checking all possible options, answering any questions, and comparing quotes.

To get started, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-998-2027.

How Small Businesses Can SHOP Around for Healthcare

One of the questions often asked by small business owners is: can I offer my employees ACA Marketplace coverage and qualify for subsidies? The answer to this is actually yes and no. If you are a small business owner looking to offer insurance to your employees, you cannot apply for the subsidies that individuals shopping on the Marketplace can. However, you can offer your employees plans that are basically identical to individual Marketplace plans, and possibly qualify for a tax credit when you do so. If you run a small business but still want to offer your employees healthcare, you may want to look into the Small Business Health Options Program, or SHOP.

SHOP Plansthree medals on lanyards, one gold, one silver and one bronze

The good news about SHOP is it’s easy to understand: the plans offered look basically the same as those offered on the individual ACA Marketplace. Just as on the individual Marketplace, there are four types of plans that are based on a “metal tier” system. You can choose from Platinum, Gold, Silver, or Bronze plans, and, as Healthcare.gov points out, the levels do not indicate quality of care; rather, the categories are based on how the cost of care will be shared by your employees and your insurance company. Cost sharing for these plans generally look like this:

  • Platinum – 90% on average paid by insurance, 10% on average paid by employee
  • Gold – 80% on average paid by insurance, 20% on average paid by employee
  • Silver – 70% on average paid by insurance, 30% on average paid by employee
  • Bronze – 60% on average paid by insurance, 40% on average paid by employee

You can also choose to add dental coverage to these plans, or even offer a stand alone dental plan to your employees if they are interested. 

How to Qualify

illustration of clipboard with a blue pen on it and blue check marks in all 4 boxes
You can qualify for SHOP as long as you meet 4 requirements.

SHOP is an easy and straightforward way to offer insurance to your employees, but not every business qualifies for it. Your business needs to meet 4 requirements:

  • Have 1 – 50 full-time (or full-time equivalent) employees. This does not include you, your spouse, or other family members.
  • Offer coverage to all full-time employees. This includes all workers averaging at least 30 hours per week. You can offer coverage to part-time employees, but you are not required to do so.
  • Enroll at least 70% of your full-time employees in your plan. However, if an employee already has another healthcare plan, they are not counted as rejecting your plan.
  • Have an office or employee worksite that is located in the state whose SHOP coverage you are using.

Also make sure to look at the specific plans offered in your state; they may have other specific requirements.

Why SHOP?

Now that we’ve looked at what SHOP actually is, let’s take a look at why it might be a good option for you and your business. As mentioned above, both the plan options and requirements are fairly straightforward. There are other advantages to it, as well:the word choice written in chalk on blackboard  with arrows all around it

  • SHOP offers you choice and flexibility. You can offer your employees one plan, or multiple options, you decide how much to contribute to their premium costs, and you can also decide how long new employees must wait before enrolling. There is also no need to wait for an open enrollment period; you can start offering your employees SHOP coverage at any time during the year. 
  • You can work with an agent. You don’t sign up through Healthcare.gov, or need to start an account with them. You can work with a trusted insurance agent or broker to help you through the process.
  • You may be able to get the Small Business Health Care Tax Credit. This is where your alternative to ACA individual subsidies comes into play. If you meet certain requirements, you can get a tax credit worth up to 50% of the costs of employee’s healthcare premiums. To qualify for the minimum credit, you must have fewer than 25 full-time employees making less than an average of around $52,000; to qualify for the maximum credit, you must have fewer than 10 full-time employees earning less than an average of around $25,000.

Health insurance is complicated, especially if you’re running a small business and trying to figure how you can do the right thing and offer healthcare to your employees. SHOP might just be a way for you to simplify things a bit for yourself – and maybe get a little of that hard-earned money back in your pocket. And remember, whatever type of group health plan you’re looking into, EZ.Insure can help. We’ll connect you with your own personal agent who will answer all of your questions, get you the most accurate quotes, and even sign you up – all for free! Get started with us today by simply entering your zip code in the bar above, or you can speak to an agent by emailing or calling 888-998-2027.

Is Medicare For All Coming? Here’s Why You Should Check Your Insurance Options Now!

The Medicare for All debate is full of disagreements between politicians in regards to it’s future. Some Democrats advocate for the single-payer healthcare system that would eliminate private health insurance companies, while others push for a government option. Republicans, on the other hand, are in favor of sticking with a private system and getting rid of the ACA. All of this uncertainty about the future of health insurance brings an uneasy feeling. Medicare for All might happen, and the ACA might disappear. No matter what the outcome, health insurance is in a safe place right now with affordable plans. There is no better time than now to check your insurance options and find a good policy. 

What Is Medicare For All?

group of people with a huge red heart in the babkground
Medicare for All is a government-run system that would replace private health insurance offered through employers.

Under Medicare for All, a government-run system would replace private health insurance offered through employers. This single-payer system would be paid for by tax dollars, and Americans would no longer pay premiums, deductibles, or any point-of-service costs for healthcare. While some see this as a good thing that would ensure healthcare for everyone, others see it as a potential disaster that would cost too much and create long wait times for care. 

A poll from the nonpartisan Kaiser Family Foundation found that 56% of Americans support Medicare for All. When people were told it could lead to higher taxes, support fell to 37%. When asked whether they would still support it if it led to delays in care, the number fell to 25%. 

However, as of now, talks of Medicare for All have been silenced; in fact, any talk regarding the future of health insurance for the U.S has been notably nonexistent. Where will this leave the health insurance industry after elections? Where will this leave you? Will Medicare for All take over? Will you have the option for private insurance, and if so, will the prices rise to unobtainable rates?

The Future Of The ACA Marketplace

On the other side of the aisle, Republicans have a less concrete plan for how to move forward. Their plan is still pushing for the repeal of the ACA: Republicans have been trying to get rid of the ACA since it was introduced by former President Obama. As of now, 18 Republican attorneys general are still planning to participate in a lawsuit that could mean the repeal of the Affordable Care Act within a year. If the ACA were to be dismantled, over 20 million Americans would lose health insurance. 

black question marks on a black floor with 2 red ones on it too

The threat of repeal is causing uncertainty about the future of healthcare because, as of now, no Republican lawmakers have proposed a replacement plan. 

A Lot Of Uncertainty

Medicare for All is a faraway dream (or nightmare, depending on who you ask) right now, and both political parties have been generally vague about their future plans for healthcare. It is better to be covered now with a secured policy than wait until the industry changes, when there are likely going to be fewer options for coverage and higher prices. Even insurers are uncertain about prices and what they expect healthcare to look like. Usually they have an idea, but not this time. 

yellow street sign that says now and later underneath it crossed out with a red line

One thing that is certain is that there are still affordable ACA plans and private health insurance plans available. Currently there are a range of plans, with different coverage and prices that can meet your health and financial needs. Recently, more ACA insurance companies announced that they have expanded into new counties around the U.S. This means there are more options than ever for getting covered. It’s a good time to take advantage of the choices available and get grandfathered into a plan, in case the insurance market changes drastically in the future.

Doing the research can be a lot of work. It can feel overwhelming when you have to compare different plans to find the one that meets your needs. We get it, and that is why EZ.Insure is here to help. We won’t try to make a profit off of your confusion, we just want to help you make an informed decision. We will provide you with your own agent, who will go over all of the coverage options and prices, and guide you towards the best plan for you for free. To get started, simply enter your zip code in the bar above, or to speak directly to an agent, call 888-350-1890

Can You Get Health Insurance at Any Time?

If you are unhappy with your current health insurance policy, then it might be time to shop for a different plan. But can you purchase a new plan at any time? Yes, and no. For marketplace plans, once the open enrollment period (November 10 to December 15) is over, you generally cannot get a new plan. The open enrollment period for employer-based insurance might be at a different time of year, but you will still only be able to change your plan during that enrollment period. In most cases, if you want to get health insurance or change your plan outside of the open enrollment period, you will need to qualify for a Special Enrollment Period (SEP). SEPs open up when you experience what is known as a qualifying life event. 

Qualifying Life Events

caucasian couple hlding a baby girl in the middle while both are kissing each cheek
You can get health insurance outside of open enrollment if you qualify for SEP such as getting married or having a baby.

You have 60 days to change your plan if you:

  • Got married
  • Had a baby, adopted a child, or took in a foster child
  • Got divorced or legally separated. However, if you do not lose coverage due to divorce or legal separation, then you do not qualify for a Special Enrollment Period.
  • Had someone on your marketplace plan die
  • Changed residence. If you move to a new home in a new ZIP code or county, move to attend school, are a seasonal worker and move between job and home, or move from a shelter or other transitional housing to a permanent residence, you will qualify for an SEP.
  • Lost your health insurance. This includes losing job-based coverage, losing a plan you bought yourself, losing eligibility for Medicaid or Medicare, and losing coverage through a family member.
  • Gained membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
  • Became newly eligible for Marketplace coverage because you became a U.S. citizen
  • Left incarceration
  • Started or ended service as an AmeriCorps State and National, VISTA, or NCCC member

Short-Term Medical Plans

If you do not qualify for any of the life events listed above, all hope is not lost. You can enroll in a short-term medical plan. Short-term health insurance provides fast, flexible insurance with many benefits. These plans can be extended up to 3 years, and you can pick your deductible amount from many options. You are also able to drop coverage without a penalty if you want to change to a long term insurance option. Premiums are lower than ACA health insurance plans, and you get coverage as soon as a day after applying.

short-term health insurance form on a clipboard

It is important to understand that short-term insurance is temporary and not ideal for those who require more comprehensive coverage or have health conditions. Short term plans are not guaranteed-issue, meaning they do not cover pre-existing conditions. They only cover the basics.

Do you qualify for a special enrollment period? If not, are you considering a short-term health insurance plan to hold you over until open enrollment begins? EZ.Insure can help. We offer accurate health insurance quotes based on your specific region, free of charge. That’s right. We will provide you with an agent who will compare all available plans for you, and help you choose a health insurance plan that is based on your health needs and budget, for free. To get your free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.