Self-Employed? Stop Overpaying for Health Insurance.

Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan’s own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage. These plans are not sold through the ACA Health Insurance Marketplace (HealthCare.gov or your state’s exchange) and are not individual-market ACA plans. You can’t use a premium tax credit or cost-sharing reduction to pay for them. As HealthCare.gov puts it, “the only way to get the premium tax credit is through the Marketplace.” Cigna is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the Cigna network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card. First Health is a provider network, not an insurance company, and it doesn’t pay claims. A plan that uses the First Health network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card. Group plans: This is a group health plan offered through a sponsoring employer or organization, not an individual ACA plan. Its Summary of Benefits and Coverage states that it provides minimum essential coverage and meets the minimum value standard. If you are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. Eligibility is set by the plan document. Some services, such as imaging, surgery and hospital stays, need pre-certification before you get them. If you skip it, the plan may charge a penalty ($500 in the plans we reviewed), and in most of those plans the penalty doesn’t count toward your out-of-pocket limit. PPO designs: Out-of-network providers may bill you for the difference between their charge and what the plan pays. That amount doesn’t count toward your out-of-pocket limit. Out-of-network preventive care and prescriptions are not covered. Limited-benefit plans: This is a limited-benefit plan. It pays for a defined list of services, with copays, visit and day limits, and caps on hospital stays, and it excludes some major treatments. Its plan materials don’t state that it meets ACA coverage standards or that it counts as minimum essential coverage. Costs above the plan’s limits are yours to pay. Benefits are subject to the governing plan document. How the “integrated gap benefit” works: The plan’s stated in-network deductible and out-of-pocket limit are higher than the reduced amount you may see advertised. The plan’s integrated gap benefit may offset eligible in-network deductible and coinsurance amounts, subject to the terms and limits of the plan. Copayments, non-covered services, penalties, balance billing and other excluded charges may not be eligible. Ask us for the plan’s Summary of Benefits and Coverage and the gap benefit’s terms before you enroll. Gap policies: Monthly rates for some plans include a separate hospital and accident gap plan. Gap benefits are subject to that policy’s own terms, limits and exclusions. The medical plan’s deductible and cost sharing are shown before any gap benefit. FreedInsure LLC is an independent insurance agency; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states. Our help is free to you, and we’ll show you your ACA Marketplace options, including any tax credit you qualify for, next to any private plan. FreedInsure doesn’t sell ACA Marketplace plans in Washington, DC; DC residents enroll through DC Health Link, and we can help them with life insurance and supplemental coverage. We are not a tax preparer or financial advisor; confirm tax deduction eligibility with your CPA.