Health insurance coverage is almost taken for granted in the United States and the vast majority of people either have or are looking for health insurance.
In fact, with the passage of the Affordable Care Act (ACA) in March of 2010, it has been technically illegal to not be insured. While, on a federal level, the tax penalty is no longer applicable, the requirement remains in place.
And, as one source points out,
“There is no federal penalty for not having health insurance since 2019, however, certain states and jurisdictions have enacted their own health insurance mandates. The federal tax penalty for not being enrolled in health insurance was eliminated in 2019 because of changes made by the Trump Administration.”
In fact, you may have to pay a penalty if you are uninsured in the following states:
- California
- Massachusetts
- New Jersey
- Vermont
- Rhode Island
- District of Columbia
For most people, however, we do have major health coverage, but we still often have out-of-pocket costs to contend with. And that’s where supplemental health insurance may be an answer.
Considering Supplemental Health Insurance
Because not everyone is familiar with it, it is fair to ask, “What is supplemental health insurance?”
Simply put, it is an additional, or extra, insurance plan that can be purchased that helps pay for healthcare costs that are not covered by a person’s regular health insurance plan. These out-of-pocket costs include copayments, coinsurance, and deductibles.
The primary purpose of any supplemental plan is to reduce medical costs by covering as much of the out-of-pocket costs to individuals as possible.
So, what examples of supplemental health insurance plans?
An article at The Balance notes that,
“[T]hese health plans include dental plans, critical illness plans, and vision plans. They include disability plans, long-term care plans, and travel insurance for health care coverage when you are outside your health plan network.”
When we purchase health insurance, we often purchase dental insurance, vision insurance, and sometimes even prescription drug coverage as well, to cover some of the cost of medications. All of these serve to make affordable health insurance a reality for many people.
In addition, there are also other types of supplemental insurance such as accidental death and dismemberment insurance, cancer policies, and hospital indemnity plans.
Perhaps the most well-known supplemental plans, especially among seniors, are Medicare supplement Insurance, or Medigap plans.
Supplemental insurance health plans may pay benefits to either the person who is insured or to the health care provider or facility. The actual amount that is paid and how it is dispensed will depend on the type of plan.
Who May Need Supplemental Insurance?
Major coverage for California health insurance, as well as most other states, is not 100 percent comprehensive. In other words, there are always out-of-pocket costs and expenses involved for health plan members.
These costs include deductibles, coinsurance, copayments, costs for medications not covered, as well as elective or cosmetic procedures, hearing aids, alternative therapies, and long-term care. When you are speaking specifically about Medicare coverage, some of the items and services Medicare doesn’t cover include:
- Long-Term Care (also called custodial care )
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care
For those on Medicare, it is quite common to purchase supplemental insurance in the form of Medicare Advantage Plans, sometimes called “Part C” or “MA Plans.”
But, if you are not yet on Medicare, as to whether a supplemental health plan is right for you, largely depends on your health, the costs of the plan you may be considering, and the benefits of the policy you’re thinking about buying.
Supplemental insurance can be a smart choice for you if you believe you have higher-than-average health risks. If you have a family history of cancer, for example, it’s worth considering cancer insurance coverage. It can also help pay for non-medical expenses that can result from illness or injury, such as lost income or childcare expenses.
In short, the essential reasons for purchasing supplemental health insurance can be summarized this way:
- Your deductible is greater than your savings account.
- You will have extra childcare expenses if you are ill or injured.
- You don’t have savings to cover being off work for a prolonged illness or debilitating injury.
The bottom line is that supplemental health insurance provides an extra level of coverage by helping meet the out-of-pocket expenses and other costs not covered by your major health insurance plan.
J.C. Lewis Insurance is Your Champion for Quality and Affordable Insurance
J.C. Lewis Insurance is a team of expert insurance brokers and a family-owned firm that has been based in Sonoma County, California, since our founding in 1979.
We are proud to offer individual and family health insurance plans only from the leading health insurance carriers licensed to do business in California and several other states. In addition, we specialize in employee benefits for small businesses with 1-100 employees.
As experienced, professional, and local insurance brokers, we are licensed and certified by each of these insurance carriers to offer coverage to individuals, families, and small group employers, in addition to offering Medicare supplemental insurance and prescription drug plans for seniors.
If you are self-employed, or your employer doesn’t provide health benefits, an individual or family plan may be the best option for you or you and your family.
When you’re shopping for supplemental insurance, vision, dental, or general health insurance coverage for your employees or for you and your family, you will likely have several questions and concerns. Which is why, at J.C. Lewis Insurance Services, we welcome your questions about insurance coverage and want you to know that you can be confident we will help you find the right solution.