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Smiling senior couple using a tablet outdoors, learning about Medicare Supplement Insurance with EZ.Insure.

What is Medicare Supplement?

Medicare Supplement plans, also known as Medigap plans, are called this because they supplement Original Medicare, and help to fill the coverage gaps in Parts A and B. While Original Medicare is a government program, Medicare Supplement Plans are sold by private insurance companies. You’ll have to pay a monthly premium to your insurance company (and you’ll have to be enrolled in Medicare Parts A and B), but you’ll end up paying less than you do with Original Medicare, since your low monthly premium will generally cover most of the out-of-pocket costs associated with Parts A and B.

 

The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Supplement Plans to provide the same benefit coverage across the country, and you will never be denied care by providers who accept Medicare with these plans, but premiums can vary by insurance company. That means it’s important to compare plans from different insurers before making your choice. EZ can help you with that, as well as with explaining how exactly these plans work. 

Medicare Supplement Plan Types

One of the many great things about Medicare Supplement Plans is that there is a wide variety of plans available, so you’re sure to find one that works for you and your budget. In 2025, most beneficiaries can choose from 10 different Medicare Supplement Plans. It is important to compare all options in order to determine which plan will best meet your needs, so below we’ve highlighted the different plans and what they cover. If you need a visual, our simple Medicare Supplement Plans comparison chart can help you, as well. 

Plan A 

Medicare Supplement Plan A only provides the basic benefits that all Medicare Supplement Plans are required to provide. That means this plan is a good choice for those who want a low-cost plan that will still help limit the expenses of Original Medicare, including the 20% Part B coinsurance, which can really add up. Plan A also literally limits out-of-pocket costs, since it has an annual out-of-pocket limit, which Original Medicare does not.

 

It covers:

 

  • Medicare Part A coinsurance
  • Medicare Part B coinsurance
  • First 3 pints of blood
  • Medicare Part A hospice coinsurance
  • Preventive care coinsurance

Plan B 

Plan B covers all of the basic things that Plan A covers, as well as some of the extra benefits offered by other Medicare Supplement Plans. Although Plan B is not the most comprehensive Medicare Supplement Plan available, it is a standout  plan for those who want some extra coverage for out-of-pocket expenses.

 

Plan B Covers:

 

  • Medicare Part A coinsurance
  • Medicare Part B coinsurance
  • First 3 pints of blood
  • Medicare Part A hospice coinsurance
  • Preventive care coinsurance
  • Medicare Part A deductible

Plan C 

Anyone who was eligible for Original Medicare before January 1, 2020, can sign up for Plan C. You cannot enroll in Plan C if you were not Medicare-eligible at that time. Medicare Supplement Plan C pays for any Medicare-approved expenses that Original Medicare does not cover. This includes annual deductibles, copays, and coinsurance, among other things.

 

It covers:

 

  • Medicare Part A deductible
  • Medicare Part A coinsurance and copays
  • Medicare Part B deductible
  • Medicare Part B coinsurance and copays
  • First 3 pints of blood
  • Skilled nursing facility coinsurance
  • Foreign travel emergency care

Plan D 

Plan D is one of the less commonly chosen Medicare Supplement Plans, but it is an excellent choice if you want coverage in the event of an emergency.

 

Plan D covers:

 

  • Coinsurance and copayments for Medicare Part A
  • Coinsurance and copays for Medicare Part B
  • Coverage for foreign travel emergencies

Plan F 

Plan F has long been the market’s best-selling plan. It covers all of your out-of-pocket expenses, so you’ll only have to pay the monthly Plan F premium if you have this plan. The only caveat is that Plan F, like Plan C, is not available to anyone who became Medicare eligible after 2020. If you became eligible for Medicare before 2020, you can buy one of these plans; if you have already bought Plan F and are grandfathered in, you can keep it for as long as you want.

 

Plan F covers:

 

  • Deductibles for Medicare Part A and Part B
  • Medicare Part A and Part B coinsurance or copayments
  • Medicare Part B excess charges
  • Skilled nursing facility coinsurance
  • Foreign travel emergency expenses up to plan limits

Plan G 

For those new to Medicare, Plan G is the most comprehensive Medicare Supplement Plan available. This plan has grown in popularity in recent years since the discontinuation of Plan F and has become one of the most popular Medicare Supplement Plans available today, if not the most popular. Plan G bridges the gap between what Original Medicare covers and the costs that you are responsible for in a very cost-effective way.

 

Plan G covers:

 

  • Medicare Part A deductible
  • 100% of hospice copayments and coinsurance
  • Additional foreign travel emergency benefits
  • 100% of Medicare Part B excess charges

Like all Medicare Supplement Plans, it is also a guaranteed renewable policy, regardless of your health.

Plan K

When coupled with Original Medicare, Plan K is an excellent choice for lowering your cost-sharing obligations. This plan, like all Medicare Supplement Plans, works to cover some of the costs that Original Medicare does not cover, but at slightly different percentages.

 

It Covers:

 

  • 100% of Medicare Part A hospital coinsurance
  • 100% of Medicare Part B preventive care coinsurance
  • 50% of Medicare Part B coinsurance
  • 50% of the cost for 3 pints of blood
  • 50% of hospice coinsurance
  • 50% of skilled nursing care coinsurance
  • 50% of Medicare Part A deductible

Plan L 

Plan L is a supplemental healthcare plan that provides cost-sharing benefits, like Plan K. With Plan L, you will be responsible for deductibles, coinsurance, and copayments, in addition to the monthly premium for your policy. Your plan, though, will have a maximum out-of-pocket limit.

 

It covers:

 

  • 100% of Medicare Part A hospital coinsurance
  • 75% of Medicare Part B coinsurance
  • 75% of the cost for 3 pints of blood
  • 75% of hospice coinsurance
  • 75% of skilled nursing care coinsurance
  • 75% of Medicare Part A deductible

Plan M 

Plan M can be an excellent fit for those who are looking to keep monthly costs low. Its coverage assists with many out-of-pocket costs that are not covered by Original Medicare alone, like copayments, coinsurance, foreign travel emergency care, and your first three pints of blood.

 

It covers:

 

  • 100% of Medicare Part A hospital coinsurance
  • 100% of Medicare Part B coinsurance
  • 100% of the cost for 3 pints of blood
  • 100% of hospice coinsurance
  • 100% of skilled nursing care coinsurance
  • 50% of Medicare Part A deductible

Plan N 

Plan N provides comprehensive benefits alongside Original Medicare coverage. With this plan, you will only be responsible for your Medicare Part B deductible, small copays at the doctor’s office, and excess charges if applicable in your situation.

 

Plan N covers:

 

  • Medicare Part A coinsurance
  • Medicare Part A deductible
  • Foreign travel emergency care
  • Medicare Part B 20% coinsurance (you will be responsible for a $20 copayment for doctor office visits and $50 copayments for emergency room visits if not admitted)

Cost of Medicare Supplement Plans

When comparing Medicare Supplement Plans, price is likely to be the most important factor (after benefits) that will affect your choice. All Medicare Supplement Plans have monthly premiums, which are often directly proportional to the level of coverage provided. Your monthly premium can also vary depending on a variety of factors, including your gender, age, tobacco use, ZIP code, and more.

 

Keep in mind that the most important factor in determining your Medicare Supplement Plan premium is the plan letter you choose to enroll in. But you should also know that men typically pay slightly higher premiums than do women, and the older you get, the higher your premium will be. This is not true in all cases. Your state may require carriers to use specific rating methods when calculating your Medicare Supplement Plan premium. Check out our individual Medicare Supplement Plan pages and our price of Medicare Supplement Plans by state pages to see more about specific pricing and the rating methods for your state and plan.

FAQs

  • Do any plans have prescription drug coverage?

No, Medicare Supplement Plans do not have prescription drug coverage. You can enroll in Medicare Part D or Medicare Advantage for drug coverage.

  • Why Are Plan C and F discontinued?

In January of 2020 a law went into effect saying that Medicare Supplement Plans were no longer able to pay for the Medicare Part B deductible. Both Plan C and F had this coverage so they have been phased out and are not available to new enrollees. However anyone who was eligible for Medicare before 2020 may still be able to buy them.

  • Will my pre-existing condition be covered by Medicare supplement plans?

Yes, as long as you sign up during the Open Enrollment Period, which is open for 6 months after you turn 65 and enroll in Medicare Part B. During this time frame you have what is known as a “guaranteed issue right” which means you can’t be denied coverage due to a pre-existing condition. If you miss the OEP then your insurance company can refuse to cover pre-existing conditions for a 6 month period.

Explore Your Health Insurance Options with EZ.Insure

If you’re looking for a Medicare Supplement Plan, it is essential that you compare the benefits and costs of each one. That means doing a lot of research, which can take a long time, since you’ll have to call multiple insurance companies to get rate quotes. 

 

But if you work with one of EZ.Insure’s agents, you can cut the time it takes to compare prices in half. Working with a licensed agent gives you access to multiple Medicare Supplement Plan carriers and plans in one place. 

 

Your agent can explain the differences between each plan, in addition to offering your price comparisons. Furthermore, your agent can help you weigh out-of-pocket costs versus premium costs to determine which plan will be the most cost-effective for you in the long run.

 

To begin shopping for a Medicare Supplement plan, enter your ZIP code on the righthand side, or call us at (888)-753-7207 today. 

 

Empty medical examination room with exam table and diagnostic tools on the wall, representing Catastrophic Health Insurance coverage from EZ.Insure.

 

Health insurance can seem like a big expense, but the cost of a plan is nothing compared to the cost of a significant medical issue. That means it’s important to have at least some sort of coverage – but what if you’re struggling to find a plan that you can afford? In this case, you might want to look into catastrophic health insurance plans.

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What Are Catastrophic Health Insurance Plans? 

Catastrophic health insurance plans are specially designed to provide basic coverage for “just in case” scenarios, and have affordable premiums. It’s important to note that these plans are not available to everyone, though. In order to purchase a catastrophic health plan, you must be under the age of 30 or meet the requirements for a “hardship” exemption.

 

Catastrophic plans are really only designed as last resort coverage, but they are a good option if you can’t afford another type of plan, because they will help you avoid a scenario in which you’re hit with a medical bill for thousands of dollars. The monthly premiums for these plans tend to be relatively low, but you will typically be required to pay for all of your healthcare expenses out-of-pocket until you reach the plan’s high annual deductible, which is typically at least a couple of thousand dollars. 

What Do Catastrophic Health Insurance Plans Cover?

Catastrophic plans are like a financial safety net in case you end up incurring large medical bills that would be impossible to pay on your own. They also include coverage for the same preventive care benefits that all ACA-compliant plans offer. This includes coverage for the ACA’s 10 essential health benefits:

 

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Mental health and substance use services
  • Pregnancy, maternity, and newborn care
  • Prescription medications
  • Preventative and wellness services and chronic disease management
  • Pediatric services
  • Rehabilitative and habilitative services

With a catastrophic plan, you will get most preventive care and up to three doctor visits a year fully covered. You will pay for most other covered services, like lab work and minor surgeries, out-of-pocket until you meet your plan’s high annual deductible. Once you meet your deductible, your catastrophic plan will pay for the rest of your essential health benefits for the rest of the year. 

 

Catastrophic plans are known for their high deductibles, and in many cases, people don’t meet the deductible in a given year. These plan’s deductibles are the same as the federally mandated out-of-pocket maximums for healthcare plans, which for 2025 is $9,200 for individuals and $18,400 for families.

 

The good thing is, with a catastrophic health plan, as with all health insurance plans, the amount you pay out-of-pocket for medical services will actually be less than if you didn’t have an insurance plan. This is because insurance companies typically negotiate reduced rates with healthcare providers. So, it’s always better to have a plan – even one with a high deductible – than no plan at all. 

What Isn’t Covered?

Because catastrophic plans have such high deductibles, they will most not likely not end up covering smaller medical expenses. Costs associated with medical services like treating a broken bone or minor illness, or seeing a specialist, will probably not meet your deductible, so your catastrophic plan will not begin covering your costs. 

Who Are Catastrophic Health Plans For?

As mentioned above, these plans are only available to two categories of people. The first is young adults under 30 who don’t have other coverage options (such as through an employer or spouse). If you are in this category, you might consider getting one of these plans if you:

 

  • Are unlikely to need medical care throughout the year
  • Want to satisfy the legal requirements in your state for health insurance (if your state has a health insurance mandate) but don’t want to buy a more expensive plan
  • Want to have basic coverage in the event that something terrible does occur

The second group is individuals 30 and over who qualify for what is known as “economic hardship.” These individuals who generally don’t have access to healthcare through an employer or spouse, can also purchase catastrophic health plans. You may qualify for a hardship exemption if you:

 

  • Have experienced homelessness within the past three years
  • Were determined to be ineligible for Medicaid
  • Have experienced eviction
  • Have been the victim of domestic violence
  • Are filing for bankruptcy 

If you believe that your current economic situation makes it difficult for you to pay for health insurance and are interested in a catastrophic plan, you’ll have to submit an application for a hardship exemption through the Health Insurance Marketplace.

 

It is important to keep in mind that even if your income puts you in a position to receive reduced healthcare costs, also known as a subsidy, you will not be able to put those savings toward a catastrophic health plan. This includes tax credits for premiums, as well as subsidies for cost-sharing. That means that no matter your income, your monthly premiums for your catastrophic insurance plan will remain the same.

How Much Do Catastrophic Health Plans Cost?

A catastrophic health plan is essentially the same thing as a high deductible health plan but with a different name, and with restrictions on who can purchase them, as already discussed. Because they have such high deductibles, they can be quite expensive if you have a number of health problems. 

 

As of 2025, the annual deductible for individual catastrophic health plans is $9,200; for families, this doubles to $18,400. This means that you will most likely have to pay out-of-pocket for smaller medical expenses, including lab work, minor surgery, or anything else other than preventive care.

 

The one good thing price-wise about these plans is that plans with high deductibles generally have relatively low premiums. So if you are healthy and don’t often see the doctor, the monthly cost might be worth it as coverage in case of an emergency, since a major medical event can be extremely expensive.

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Pros of Catastrophic Health Insurance Plans

The following are some of the benefits of having a catastrophic health insurance plan:

 

  • In comparison to those of other types of health insurance, the monthly premiums are typically much more affordable.
  • Your coverage acts as a financial buffer, protecting you from the potentially catastrophic effects of a major illness or medical emergency.
  • If you are generally healthy and don’t require many medical services, you might find that your overall insurance and care costs are lower than they would be with either another plan or no plan at all.
  • Insurance companies typically negotiate lower rates for services with healthcare providers, so your out-of-pocket costs for care could be lower with a plan than they would be without one.

When determining whether or not a catastrophic plan is the best option for you, your current state of health is an important factor. If you are generally healthy, a catastrophic plan may be a good option. This is especially true if you have an emergency fund that can pay for any medical care you require up to the amount of your plan’s deductible.

Cons Of Catastrophic Health Insurance Plans

It’s important to note that catastrophic health insurance plans come with a number of significant drawbacks, including the following:

 

  • Because you will only be covered for preventative care, a limited number of visits to primary care providers, and the most expensive type of care, the benefits of your medical coverage will be severely limited.
  • Because your deductible will be very high, you will need to come up with a significant amount of money in the event that you require medical services, which can be a problem for a lot of people.
  • You will not be eligible for premium assistance through the Affordable Care Act (ACA).
  • You will not be able to open a health savings account (HSA), as you would be able to do with other qualified high-deductible health plans. With a health savings account (HSA), you can set aside money before it is taxed to use for medical expenses.

A catastrophic plan is not the best option for you if you are planning to have a baby or otherwise anticipate needing a significant amount of medical care during the course of the year.

 Are Catastrophic Health Plans Worth It?

A catastrophic health insurance policy could be beneficial to have if you cannot obtain health insurance from another source. In this case, one of these plans will typically be the most cost-effective option, and it may be significantly less expensive than other available choices, such as COBRA coverage. A lot of people use this type of plan as a short-term solution for their emergency insurance needs.

 

It is most likely worthwhile to purchase a catastrophic insurance policy, since they have low premiums. Having one will protect you from incurring potentially bankrupting medical expenses in the event of an emergency or illness.

Working With EZ

If you find yourself in a bind, EZ.Insure is here to assist you. Our agents are incredibly knowledgeable. They can comb through all of the health insurance plans available in your area to find the right one for you. We have numerous coverage tiers and plan options available, and answer all of your questions. The best part is that everything we do is totally free! 

To get your free quotes, simply enter your zip code into the space below, or give us a call at (209)-593-6584.

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Top-down view of a laptop keyboard and an open planner with wooden letter tiles spelling out "Health Insurance," representing individual HMO health insurance plans from EZ.Insure.

 

A Health Maintenance Organization (HMO) is a type of affordable health insurance plan that offers a network of providers you can choose from for your healthcare needs. HMOs can give you coverage at lower rates because their networks are more limited and less flexible than those of other types of plans.

 

Lower rates but less flexibility are the two key components of HMOs, but there are other things you should consider when trying to decide if an HMO is right for you. So, if you’re considering an HMO, it’s important to understand how they work and how they differ from other plans.

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How HMOs Work

An HMO’s care network is the key to its coverage. The providers in an HMO’s network, like doctors, hospitals, labs, and specialists, all have contracts with the plan, and are paid to offer a variety of health services to policyholders. These plans often have a geographic service area, meaning you’ll have to see providers in your specific area, and the fees associated with the plan will be determined based on your area’s specific population.

 

While HMOs have less flexibility than other plans, they have lower premiums. Their limited networks, and the fact that the providers in the network have patients directed to them, means savings gets passed on to you. 

What Makes HMOs Unique

A key difference between HMOs and other plan types is that you are required to receive care from the providers in the HMO’s care network. There are a few exceptions to this:

 

  • You have a medical emergency – You can see a provider outside of your network if you need immediate care (if you’ve been in a life-threatening accident, for example)
  • Your plan does not have a provider – In the rare case that your HMO network doesn’t have a provider for the care you require, you might be able to receive coverage for a provider outside of your network. Your HMO would decide on a case-by-case basis if they would cover the care.

Aside from those circumstances, any care you receive outside of the network will not be covered.

 

Another key difference with an HMO is that you will have to choose a primary care provider (PCP) when you set up your plan. Your PCP will handle all of your general healthcare needs and help you navigate the HMO system. They will also be in charge of giving you referrals if the need for more specific care arises. You’ll need a referral to:

 

  • See a specialist
  • Receive physical therapy
  • Get medical equipment like a wheelchair

The Cost

As with all healthcare plans, policyholders pay monthly or annual premiums to access medical care. With an HMO insurance plan, you’ll benefit from lower costs, meaning you’ll have lower premiums, deductibles, and copays. You’ll also receive better care coordination, because you will be limited to seeing in-network doctors. 

 

An HMO health insurance plan premium is determined by a variety of factors, including location, age, plan tier, and if you have any dependents on your plan. An example of premium rates for an HMO would look like this: 

 

  • 21-year-old – Single $342, couple $684, couple with 1 child $944
  • 30-year-old – Single $390, couple $780, couple with 1 child $1,040
  • 40-year-old – Single $438, couple $877, couple with 1 child $1,1,37
  • 50-year-old – Single $613, couple $1,226, couple with 1 child $1,487

Along with lower premiums, there are often low or no deductibles to meet with a Health Maintenance Organization. Instead, a copay is required for each clinical visit, test, or prescription. HMOs typically include low copays ($5, $10, or $20 per service on average), which reduces out-of-pocket costs and makes HMO plans more affordable.

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Types Of HMOs

HMO plans come in a variety of forms, each having benefits and drawbacks. Although specific HMO plans are each unique, most of them now include features that all HMO plans have in common. These standard types of Health Maintenance Organization plans are called models. The three main HMO model plans are:

 

  1. Staff model – In this type of plan, also known as a closed-panel HMO, doctors and other medical specialists work directly for the HMO. In other words, doctors and medical professionals have offices in HMO buildings and are paid directly by the HMO. These doctors can only provide treatments to HMO members.
  2. Group model – Healthcare providers in the group model are contracted to provide care at a fixed rate but are not directly employed by the HMO. Only patients who have joined the HMO are seen by this group of doctors.
  3. Network model – The network model HMO does not directly employ healthcare workers and has contracts with various medical groups. This means that the facilities and doctors in this model don’t exclusively see this plan’s policyholders. 

HMO Pros and Cons

HMO plans have plenty of benefits. But as with any insurance option, there are some drawbacks as well. Depending on your situation, the benefits of this type of plan might outweigh the drawbacks. To help you decide if this is the case for you, take a look at the main pros and cons of HMO plans:

 HMO Pros

  1. Affordable premiums – HMOs are typically less expensive than other forms of health insurance, because all of the providers in the plan’s network have agreed to accept a set amount of money for all of the services that are available.
  2. Lower out-of-pocket costs – You will most likely pay less with an HMO plan for deductibles, copays, and coinsurance.
  3. Coordinated medical care – Your care is coordinated by a PCP under an HMO, which can mean getting better targeted treatment, and can remove the uncertainty associated with locating reliable specialists.

HMO Cons

  1. No coverage for out-of-network care – Except for the circumstances we mentioned above, HMO plans do not cover care from physicians outside their network. You will be responsible for the cost of any out-of-network medical care you get.
  2. Required referrals – HMOs require you to first get a referral from your PCP in order to see a specialist. Without the referral your care will not be covered.
  3. Limited providers – HMOs have restrictions on the physicians and facilities you can go to if you want your health insurance to pay, as they only cover in-network treatment.

Types of Care Covered by HMOs

While every plan has its own list of services it covers, Health Maintenance Organizations have three basic coverage categories. The three categories are primary, urgent, and emergency care.

 

  1. Primary care – Your PCP is in charge of your primary care. Primary care includes preventive care, like screenings or vaccines to prevent illness, as well as routine care for non-life-threatening illnesses like sore throats and fevers. It also includes follow-up care to monitor any mild health conditions like strep throat or ear infections.
  2. Urgent care – When you have an illness that poses a risk but isn’t life threatening, you should go to an urgent care facility. Issues like a high fever, unexplained pain, or an accident can be treated at an urgent care facility. As long as you visit an authorized facility, your plan will cover urgent care.
  3. Emergency care – You should dial 911 or rush to the closest emergency room as soon as possible if you experience an unexpected health emergency. Injuries like broken bones and illnesses with high fevers or excruciating pain that could permanently harm your health must be treated right away. Inform your primary care doctor about your visit to the emergency room. And if you need additional care, they can arrange it. 

Your specific Health Maintenance Organization plan might cover other services, it just depends on the specific plan you choose.

To see health insurance costs and information specific to your state click here!

 

Choosing An HMO Plan

Given that most healthcare plans are similar when it comes to quality. The decision between Health Maintenance Organizations and other healthcare plans often comes down to cost and flexibility. Although Health Maintenance Organization network plans are less expensive than other types of health insurance. They offer fewer choices and have more limitations. 

 

If flexibility is your primary concern when selecting a plan, a Health Maintenance Organization should not be your first choice. However, an HMO can be a good choice if cost is your main concern. Especially since prevention, wellness, and coordinated care are trademarks of these health insurance plans.

How To Enroll in a Health Maintenance Organization

Anyone who resides or works in an HMO’s coverage region is eligible to enroll. The three most common ways that people enroll are:

 

  • Through an employer – HMOs are one of the more popular private insurance options provided by companies. Around 16% of insured employees in 2021 selected an HMO plan as their employer-provided insurance.
  • Medicare – A Medicare Advantage Plan, commonly known as Medicare Part C, offers an HMO plan to eligible beneficiaries.
  • ACA Marketplace – Many HMO plans are available through the healthcare marketplace.

FAQs

  • What is a Health Maintenance Organization?

HMOs are a type of health insurance plan that usually only covers care from doctors who contract with or work for the HMO. It won’t cover care outside of the network unless it’s an emergency. You may also have to live or work in the plan’s service area to be covered.

  • Is a Health Maintenance Organization better than a Preferred Provider Organization?

Whether it’s better to have an HMO or PPO depends on a number of things, like how healthy you are, how much freedom you want to have in choosing doctors and healthcare facilities, and how much money you have in your budget.

 

A Preferred Provider Organization (PPO) gives you more choices when it comes to doctors and facilities than an HMO does. You don’t need a referral from your primary care doctor to see a specialist, and you can pay more to see a healthcare provider who isn’t in your network. Also, co-payments and/or deductibles are often higher with PPOs.

  • Is a Health Maintenance Organization better than an Exclusive Provider Organization?

Like an HMO, an EPO is a limited type of health insurance that only covers services received through the network of providers, except in cases of emergency. Beneficiaries don’t have to choose a PCP as their main care provider, which is a big difference from HMO and POS plans. Another difference between EPOs and HMOs is that you don’t need to get permission ahead of time to see a specialist in your network.

  • Is an Health Maintenance Organization right for me?

Whether or not you join a Health Maintenance Organization plan depends on your personal situation. Make sure to do research and think about all your benefits options before making a decision. Getting to know the different kinds of insurance plans is very helpful when it’s time to sign up for coverage during open enrollment.

 

Take some time to learn about your coverage options and the networks of doctors, dentists, and eye doctors before you sign up for a plan. Ask about any costs you might have to pay out of pocket. And make sure you know what to do in an emergency.

The Bottom Line

Everyone should give serious thought to their health insurance. However, your specific situation, including your health, finances, and quality of life, will determine the best plan for you. A Health Maintenance Organization offers its plan members fewer out-of-pocket expenses but has more strict requirements, including which doctors you can see.

 

Whatever your needs are, be sure to consider the plan’s advantages and disadvantages before you make your decision. To get started, simply put your zip code into the box below or give one our licensed agents a call at 209-593-6584.

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Hand selecting a medical cross icon among other healthcare-related symbols, representing COBRA insurance for individual health coverage – EZ.Insure

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What is COBRA Insurance?

The Consolidated Omnibus Budget Reconciliation Act, widely known as COBRA, was created in 1986 as part of the larger Employee Retirement Income Security Act of 1974 (ERISA). It gives certain workers the right to pay premiums and keep their group health insurance coverage in certain situations. Before Congress passed the ERISA law, people who had health insurance through their employer lost it as soon as they left their job for any reason.

 

After COBRA was passed, workers who left a company that offered health insurance could choose to keep their coverage temporarily. COBRA coverage is often more expensive than what active employees pay for their group health plan because the company typically pays for some or all of the coverage. 

 

Under COBRA employers are no longer responsible for any health insurance costs. All medical bills can be charged directly to the ex-employee who is receiving the services. COBRA is usually offered to qualifying employees for anywhere between 18-36 months. However, COBRA eligibility and how long the coverage continues depends on certain circumstances.

Who Is Required To Offer COBRA?

Business with 20 or more employees that offer a group health plan,  are required to also offer COBRA insurance. Even if a company doesn’t have 20 full-time employees, they may still be required to offer COBRA coverage. This is because COBRA adds up the hours of two or more part-time workers to make one full-time worker. For example, if a company has two part-time employees who each work 20 hours per week, the law views this the same as one full-time employee. 

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What are Mini-COBRA Laws?

Another thing to think about is that even if a company has less than 20 full-time equivalent employees,  your state might still require COBRA insurance to be offered. Some states have what are called, “mini-COBRA” rules aiming to cover employees providing health insurance but have fewer than 20 employees.

 

Like federal COBRA, mini-COBRA laws require group health plans to provide continuing health coverage to eligible employees who would otherwise lose coverage due to a qualifying event. In a few states, the number of workers is between 2 and 19. Other states require almost all businesses, no matter how big or small, to follow the rules of mini-COBRA.

 

The length of coverage changes by state. It can be as short as 2 to 6 months or as long as 39 weeks or even forever if the employee meets certain conditions, such as becoming totally disabled while working. In some places, employees are eligible for mini-COBRA even if they were fired for being a bad employee. There is some kind of mini-COBRA law in the following 40 states:

 

  • Arkansas
  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Florida
  • Georgia
  • Illinois
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • Mississippi
  • Missouri
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming

If a business is subject to mini-COBRA laws, they must let eligible workers know about their rights to keep coverage. The date for giving notice varies by state, so check your state’s laws to make sure you get the word out on time.

Who Qualifies for COBRA Insurance?

Types of Employees

Employees may be qualified for COBRA continuation coverage if they are enrolled in an eligible group health plan and meet certain qualifying event requirements. This could include:

 

 

  • Full-time employees
  • Part-time employees
  • Spouses of eligible employees
  • Dependents of eligible employees
  • Retirees

There are limits to how long a company has to offer COBRA coverage. Even if the business has at least 20 employees, some employees won’t be able to get COBRA coverage because they didn’t choose a qualifying plan, they were fired under certain circumstances, or other special situations including:

 

  • Employees who are ineligible for coverage in the group plan
  • Workers who declined to participate in the group health coverage
  • Employees who are enrolled for benefits under Medicare
  • Employees terminated for gross misconduct

Qualifying Events

In addition to being an employee and being enrolled in a qualified group health plan, an employee must also experience a qualifying event to gain continued coverage. This usually includes something that causes the employee to lose their group health benefits such as:

 

  • Job loss, whether voluntary or involuntary (except in the case of gross misconduct).
  • Reduction in work hours, resulting in the loss of employer-sponsored health insurance

COBRA coverage can also extend to an employee’s spouse and dependents if the qualifying event affecta the family’s ability to keep their health insurance. Qualifying events affecting spouses and dependents include:

 

  • An employee’s job is lost, or hours are reduced causing his dependents and/or spouse to lose coverage
  • A spouse gets divorced or legally separated from the covered employee.
  • The covered employee passes away
  • The covered employee becomes eligible for Medicare, and causes dependents to lose coverage

Employer Responsibilities

Plan administrators are required by law to tell employees who qualify for COBRA, when their status changes. In some cases, the employer themself is in charge of running the plan. If an employer has employees that qualify for COBRA, they are legally responsible to do the following:

 

  • Tell the group health plan administrator within 30 days of a qualified event if a person is eligible for COBRA.
  • Give notice to employees who are qualified for COBRA within 44 days about their COBRA rights.
  • If COBRA coverage is rejected for any reason, let the people who need it know within 14 days.
  • If the employee chooses to keep coverage under COBRA, give them the same coverage as the plan they were on before the qualified event.

Once an employee has a qualifying event, COBRA requires group health plans to give the employee and any qualifying dependents ample time to decide if they want to keep their coverage under COBRA. More specifically, the employee must have 60 days to choose to keep benefits or not.

 

Even though everyone in a household may have experienced the same qualifying event, they can make different decisions regarding continued coverage. For example, the employee, their partner, and any qualifying dependents can each choose whether or not they want to keep their coverage, depending on what’s best for them.

Health Insurance Alternatives to COBRA

If you experience a qualifying event, but either your employer doesn’t offer COBRA benefits, or COBRA benefits are simply too expensive for you to pay for, you have other options. Depending on your financial situation and personal preferences, you can get:

 

  • Marketplace Health Insurance: These are Affordable Care Act (ACA) plans purchased through the Health Insurance Marketplace. It’s also important to not that after losing employer coverage, you’ll qualify for what’s called a Special Enrollment Period (SEP), allowing you to sign up for a new health plan outside of the normal Open Enrollment Period.
  • Short-Term Health Insurance: This specialized coverage provides temporary insurance covering essential healthcare needs. A downfall of these plans is that they generally have limited benefits compared to traditional coverage.
  • Medicaid: Depending on your income, you could qualify for Medicaid, which is a stat-run program that offers low-cost or free health coverage.
  • Private Health Insurance Plans: These are standard health insurance plans purchased directly through an insurance company or broker.

How EZ Can Help

It’s crucial to understand the laws and requirements regarding COBRA, so that you know your health insurance rights after leaving a job or experiencing another qualifying event. Even though COBRA coverage is a great option for many individuals, for others, it’s either not available at all or simply unaffordable. If this is the case for you, don’t worry, you have other options, and EZ.Insure is here to help you explore all of them.

 

EZ.Insure makes it simple get the protection you deserve. Our user friendly-platform offers free, no-obligation quotes, a side-by-side health plan comparison tool, and 24/7 access to expert insurance agents.

 

To get started, and learn more about your health coverage options,  simply enter your zip code in the bar below or call 209-593-6584 to talk to an agent.

 

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