Individual ProductsProviding area businesses and individuals with comprehensive, cost-effective and value-added health benefits with packaged solutions

If you are not offered coverage through your job, then you do have the option to get coverage in the individual market. If you need major medical coverage that covers pre-existing conditions, then you must enroll into a Qualified Health Plan (QHP). You can only enroll into a QHP during the Open Enrollment each year from November 1 – December 15. Outside of the Open Enrollment, you can enroll into a QHP but only if you have had a Qualifying Event with 60 days (such as losing employer coverage). If you have not had a Qualifying Event, you can enroll into a Short Term Medical Plan. Whatever your situation may be, Harbour Health Insurance will help you understand your options so that you can get coverage. Our agents have the knowledge and expertise to help you decide which plan best suits you and we will assist you with this process at NO additional cost for our services.

MAJOR MEDICAL
Since the Affordable Care Act (ACA or Obamacare) went into effect in 2014, major medical individual health insurance is now available to everyone regardless of age or health conditions. There are no exclusions for pre-existing conditions nor can the carrier charge you a higher rate for a pre-existing condition. Rates are simply based on Age, Location, and Tobacco Use. Under ACA regulations, all Qualified Health Plans (QHP) must cover 10 Minimum Essential Benefits, including maternity and certain preventive tests.

Open Enrollment for ACA plans is November 1 – December 15. This is the time of year when you can enroll into your plan for the upcoming year. Outside of Open Enrollment, you can enroll into an ACA plan but only if you have recently had a Qualifying Event (such as losing employer coverage within 60 days). If you need individual coverage, Harbour Health will help you determine what coverage is best for you and your family. Under the ACA rules, your income may also qualify for a subsidy/tax credit which can lower your premium significantly. We will guide you through this process and assist you with understanding all the different plans so that you can enroll into a plan that best suits your needs. Our agents have the knowledge and expertise to help you decide which plan best suits you and we will assist you with this process at NO additional cost for our services.

SHORT TERM MEDICAL
Short term medical plans are available to those who do not have a Qualifying Event and need to obtain coverage outside of the Open Enrollment. Short term plans are designed to provide coverage for a specific period of time. They generally cost less than ACA plans because they do not cover pre-existing conditions nor preventive tests. However, they do provide good coverage at an affordable cost.

Frequently Asked Questions

Do I pay for your services?

No. We do not charge extra fees for our services. Whether you go through an agent to obtain health coverage or you go directly to the insurance company or marketplace, you will pay the same monthly premium for the same policy.


What is the benefit of meeting with an insurance broker?

Health insurance coverage is a complex product. It is important to know the options available to you so you can make an informed decision. We help you navigate through those options so you can choose the right one for you.


What do I do if I have lost my employer-sponsored health coverage?

You may have an option to keep your coverage through State continuation or COBRA, depending on the size of your company. You also have a qualifying event to make you eligible for a special enrollment period to purchase individual coverage (Affordable Care Act) outside the Open Enrollment Period. You have 60 days from when your employer coverage expires to obtain coverage thru the Affordable Care Act. We will help you research the options so that you make the right choice.


What if I can't afford it?

Under the Affordable Care Act, if your household income is within certain limits, then you may be eligible for a subsidy which can significantly lower your monthly premium. We will help you determine if you are eligible for subsidy.

I missed the Open Enrollment Period. Can I still get health coverage?

If you did not enroll into a health plan during the Nov 1 – Dec 15 Open Enrollment, you can only enroll into ACA coverage if you have a Special Enrollment Period. You are eligible for a Special Enrollment if you have a Qualifying Event, such as Loss of Employer Coverage or Medicaid, Relocation, Birth of Child, Marriage/Divorce. You must enroll within 60 Days of the Qualifying Event. If you have not had a Qualifying Event, then you can enroll into a Short Term Medical Plan which will provide coverage until the next Open Enrollment Period.


What are my coverage choices under Medicare?

Option 1: Original Medicare includes Part A (Hospital/Inpatient) and Part B (Outpatient/Physician/Diagnostics). You will want to purchase a Supplement Plan (Medigap) to “fill the gaps” in Parts A and B, such as deductibles, coinsurance, etc. You will also need a separate Medicare Drug Plan (Part D). Medicare Supplement combined with a Drug Plan usually provides you with the best coverage and gives you the freedom to see any provider that accepts Medicare. Option 1: Medicare Advantage (Part C). This is an “all in one” alternative to Original Medicare, which includes your medical coverage and drug coverage. However, you may be subject to more out-of-pocket costs for services and you will most likely need to use in-network doctors/providers.