4. The Health Insurance Landscape Today
Clients shopping for individual health coverage today fall into a few categories. Understanding which bucket they are in determines which solution fits:
|
Client Type |
Situation |
Best Fit |
|
Low-income / subsidy-eligible |
Income 100–400% of federal poverty level; qualifies for ACA tax credits |
ACA Marketplace plan |
|
Self-employed, healthy |
Does not qualify for subsidies or subsidy value is minimal; wants affordable PPO |
Our plans (Optimum Health Saver) |
|
Lost group coverage |
Recently left employer; COBRA too expensive; needs bridge coverage |
Our plans |
|
1099 / gig worker |
No employer coverage; budget-conscious; healthy |
Our plans |
|
Complex medical needs |
Chronic conditions requiring frequent specialist care, ongoing Rx, or surgeries |
ACA or refer out |
|
Short gap in coverage |
90 days or less between jobs or life events |
Short-Term Medical (STM) |