Open Enrollment is in full swing for the Affordable Healthcare Act marketplaces through December 15th.  This is the only time of year to shop or change your individual health insurance plan outside of a Qualifying Life Event.  Navigating the various plans and coverage options can be daunting, especially for sex workers, and with the addition of ‘bare-bones’ plans now meeting the minimum essential requirements to avoid the tax penalty the options and process have become even more confusing.   FSC has partnered with Reisert Insurance to provide the Adult Industry, its workers, and independent artists with a stigma-free portal to enroll in the individual marketplace insurance. We sat down with Ben Curtis of Reisert Insurance to get answers for some of the most frequently asked questions about purchasing insurance through the marketplace.

What should I pay attention to when choosing?

The first step to picking a plan is to approach it with the mindset of ‘How much will I use this?’ If you have pre-existing conditions or find yourself sick more often than not, it’s worth it to buy a better plan.  Your first key term is the ‘deductible.’ This is what you have to pay out of pocket before you hit the ‘co-insurance’ threshold, but you will still receive the benefit of negotiated rates on procedures from your insurance carrier.  After you’ve reached your deductible, the insurance policy will begin to pay a percentage, typically 80% of each bill called a ‘co-insurance.’ For example, if you have a $1,000 deductible, with an 80% co-insurance, and receive a $5,000 bill; you pay the first $1,000, the insurance company pays 80% of the remaining $4,000 ($3,200) leaving you with an additional $800 bill.  The final major piece is the ‘Out of Pocket Maximum’ (OOP) which is the most you can pay in a policy year. Every medical bill beyond the OOP is covered in full, so the lower your OOP the lower your total risk.

What is an HSA and should I get one?

Health Savings Accounts (HSA) are available for some high deductible health insurance plans.  These are tax advantage accounts that you can put money into to pay for healthcare related expenses that rolls over from year to year.  If you’re someone who rarely goes to the doctor, this is a great way to offset the higher deductible you’ve probably chosen as well as stash some money away that allow you to write off on your taxes at the end of the year.

What are the new barebones plans?

Barebones plans were designed to appeal to people ineligible for a group health insurance plan who want enough coverage to not be penalized, but who cannot afford or don’t want to pay for a full plan.  These plans usually include very limited benefits; for example, some plans cover no in-patient procedures, but are supplemented with a Hospital Indemnity plan which pays a specified dollar amount per day and an additional amount for certain procedures.  Barebones plans usually have very high deductibles, copays and some unique cost sharing measures built in as well as lacking negotiated rates provided by using a true health carrier.

I have a business entity, what are my options?

Two unmarried people on payroll are eligible for a group rate under a business.  Using the business as a vehicle for health insurance provides better rates, better plans, and tax advantages.  In addition to the traditional exchange plans, small groups are eligible to go through underwriting to achieve greater savings and lower rates.  

How do the FSC’s NexGen Benefits work with my health plan?

All FSC Individual Memberships now come embedded with the NexGen benefits suite.  While these benefits are not insurance, they work in coordination with health plans in a variety of ways.  The Teladoc feature allows you to skip the copays (if your plan has them) and have a consultation with a live doctor via your phone, tablet or computer.  Additionally, they can even call prescriptions in to your pharmacy for you which are discounted with your FSC Individual Membership. One of the most effective ways to lower your healthcare spend is to negotiate the prices once you receive the bill.  Facilities almost always over bill, utilizing the Health Advocate Solutions benefit can help untangle medical bills, and negotiate payment arrangements with providers.

black and white headshot of Ben Curtis

Ben Curtis and his team at The Reisert Group have utilized over 130 years of industry experience to create a unique marketplace tailored to the Free Speech Coalition and its members. As an independent insurance agency, our goal has always been simple: to pair you with the best coverage at the best price. Period. Great prices and great coverage are just a couple of reasons why thousands of customers and associations nationwide have their insurance needs met by The Reisert Group. Become part of our ever-growing family of customers to discover more

Ben Curtis, Agent
The Reisert Group, LLC
License #: 16789913

Tel: (502) 458-0122

1700 UPS Drive Suite 105
Louisville, KY 40223