When a Non-Qualified Health Plan May Be Best for Your Budget

While the Affordable Care Act has pushed insurance companies to provide broader services, it pays not to ignore health plans that do not meet its requirements.

Choosing a health plan is an important decision for your finances and your well-being. Part of what makes healthcare decisions difficult is the fact that there are many different characteristics and options for health plans.

In addition, insurance companies often alter old plans and introduce new ones each year, so you have to pay close attention to the market to get the best deal. In order to help you know what insurance is the best option for you, we’re diving in to explain one key consideration that defines some health plans: whether or not each plan is “qualified” under the Affordable Care Act.

What to Know About the Affordable Care Act (ACA)

The Affordable Care Act, sometimes known as Obamacare or ACA, made many changes to the health insurance industry. On one hand, these changes made insurance plans more robust by requiring companies to include and cover more than they have before. On the other hand, these features tended to make insurance coverage more expensive for some people.

Qualified vs. Non-Qualified Health Plans

A qualified health plan is one that’s in compliance with all the provisions of the ACA. It meets all the regulatory requirements, but may be expensive. On the other hand, non-qualified health insurance plans choose not to comply with one or more of the requirements of the ACA and therefore are significantly cheaper.

Whether a qualified or non-qualified plan is right for you depends on your budget and health status. The Affordable Care Act includes subsidy programs to help low-income households get cheaper access to compliant plans. However, they only kick in at certain income levels, which depend on your family size.

There are many people who are in a difficult financial position that cannot easily afford a qualified plan but are making too much to get a federal subsidy that would reduce the cost of such a plan. It becomes a challenge to manage as an individual because going without health insurance is risky, but it also isn’t easy to find an affordable plan in the current market.

Non-qualified plans can fill this need because they have lower premiums, but there are some things that you should know before choosing a non-qualified plan.

What to Consider Before Choosing a Non-Qualified Health Plan

Pre-Existing Conditions

The first consideration is the issue of pre-existing conditions. One of the biggest provisions of the Affordable Care Act was that it required insurance companies to stop making coverage decisions based on whether you have a pre-existing condition. A pre-existing condition might be something simple, like a broken arm, or more complex, like diabetes or cancer.

Under a qualified plan, insurance companies cannot deny coverage to someone on the basis of a pre-existing condition, but a non-qualified plan is not bound to such a distinction. That means that while the plan will be much cheaper, you might face increased premiums or be denied coverage if you do have a pre-existing condition that requires medical care.

Think carefully about your medical needs and any chronic conditions you may have. If they are significant and require care, then a non-qualified plan might not be a good fit for you.

A pre-existing condition might be something simple, like a broken arm, or more complex, like diabetes or cancer.

Substance Abuse

Another healthcare service that will not be covered by a non-qualified plan is substance abuse treatment. The medical care for substance abuse includes many different possible treatments, such as inpatient stays at a rehab facility, therapy, and methadone maintenance treatment.

Substance abuse is a challenging condition and care for substance abuse is not cheap to pay for out of pocket. This is similar to the concept of a pre-existing condition, although the care for substance abuse is less predictable.

Maternal Care

The third major condition that is not likely to be covered under a non-qualified plan is maternal care. Unlike substance abuse and a pre-existing condition, maternal care can be planned, at least to an extent. Maternal care is quite expensive without coverage, and there are many phases of such care.

The doctor visits, nursing consultations, birthing equipment, hospital bed space, medication, scans and imaging, and all the rest adds up. It becomes more expensive as you get closer to your due date, too. If you believe that maternal care will be important for you and your family, then a non-qualified plan is probably not going to cover what you need.

Is a Non-Qualified Health Plan Right for You?

The bottom line is that a non-qualified health plan can potentially save you a lot of money, but these plans are not for everyone due to the potential gaps in coverage. Think about your medical needs and take a look to see if you qualify for a subsidy for a qualified plan. If not, then a non-qualified plan could be a big savings for you.

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