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Cowan for Individuals

Due to recent shifts in the marketplace, Cowan is no longer able to offer individual and family benefit services.

We will be updating this portion of our website on how to continue your policy as soon as more information becomes available. See below for Frequently Asked Questions regarding individual coverage.

 

To view the health insurance plans available to you at this time, you can contact the carriers offering coverage directly or visit healthcare.gov for an overview.

If you are eligible for a subsidy based on your income, you will need to apply through healthcare.gov. If you are not subsidy-eligible, you can apply directly through the health insurance carrier if they have that option available. If that option isn’t available, you will also need to apply through healthcare.gov.

The number of policies and insurance carriers that are available to you depend on what region you live in. Below is a brief overview for the Nashville area. To see what plans are available to you in a different region, please visit healthcare.gov/see-plans/.
 

  • Humana
    • Humana has 3 plans available: 1 Bronze, 1 Silver, and 1 Gold.
    • Click here to apply directly on the Humana website.
    • Click here to see their plans available through healthcare.gov and/or apply for a subsidy.
    • To check if your doctor is in their network, click here and search in their “Nashville PPOx” network.
       
  • Cigna
    • Cigna has 8 plans to select from: 3 Bronze, 4 Silver, and 1 Gold.
    • Click here to apply directly on the Humana website.
    • Click here to see their plans available through healthcare.gov and/or apply for a subsidy.
    • To check to see if your doctor is in their network, click here and search in their  “Connect” network.
       
  • Farm Bureau
    • Farm Bureau is offering several ACA-compliant plans for 2017.
    • Visit their website here and click on “Quote & Apply” then “Medical & Dental” to apply directly on their website.
    • They offer ACA-compliant policies but they do not qualify for financial subsidies. You can learn more about their plans here.
    • They use the United Healthcare Choice Plus network. To search their provider network, click here, then “Find a Physician, Hospital or Health Care Facility” then select “All UnitedHealthcare Plans” then “Choice Plus.”
       
  • Aetna
    • Aetna is only offering one Bronze-level plan for 2017 and it is only available directly through them. It is not subsidy-eligible.
    • You can find more details about their plan on their website.

If you are interested in purchasing a short-term policy, you can do so through UnitedHealthcare here. Just note that these plans do not exempt you from the individual mandate.

 

FREQUENTLY ASKED QUESTIONS

Q:What does mandated coverage mean?
A:

The Affordable Care Act (ACA) includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Mandated coverage went into effect in early 2014.

Q:What are the requirements?
A:

Minimum essential coverage is defined as:

  • Government-sponsored programs like Medicare or Medicaid
  • Employer-sponsored plans
  • Individual market plans, including grandfathered plans
  • Other health benefits coverage recognized by the HHS Secretary

Minimum essential coverage does not include insurance consisting of excepted benefits, such as dental-only coverage.

Q:Is anyone exempt from the mandate?
A:

Individuals with a religious exemption, unauthorized immigrants, and incarcerated individuals are exempt from the minimum essential coverage requirement. Click here to learn more and apply.

Q:What is the Health Insurance Marketplace?
A:

The Marketplace, also known as the health insurance exchange, is a new way to find affordable insurance coverage so no one is left uninsured. With one application, you can see all your options and enroll.  Depending on your income and family size, you may be able to lower your costs on premiums when you purchase a private insurance plan through the Marketplace. You may also qualify for lower out-of-pocket costs or for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP).  You can also enroll directly through most health insurance carriers on their website or by phone.

Q:What is Open Enrollment?
A:

Open enrollment is the window at the end of the year when anyone can apply for a major medical policy that will start January 1st. Outside the Open Enrollment Period, you can only enroll in a health insurance plan if you qualify for a Special Enrollment Period such as getting married, having a baby, or losing other health coverage.

Q:What benefit plans are available?
A:

All plans offered through the Tennessee insurance exchange will meet the ACA definition of a qualified health plan (QHP). QHPs are certified plans that provide a core set of benefits called essential health benefits, so consumers can compare plans on an apples-to-apples basis.   Different plan categories will affect your monthly premium costs and what percentage you pay for things like hospital visits or prescription medications. The category also affects your total out-of-pocket costs—the total amount you’ll spend in a year if you need extensive care.  Each of the categories offers the same essential health benefits. The categories don’t reflect the quality or amount of care the plans provide.

Q:What are the different plan categories?
A:

The Marketplace offers four categories of insurance plans: Bronze, Silver, Gold and Platinum. The categories are based on how much of the costs of care you pay, versus what the plan covers. The Bronze plan pays 60 percent, the Silver plan pays 70 percent, the Gold plan pays 80 percent, and the Platinum plan pays 90 percent.

Q:What carriers are available?
A:

The list of carriers who are offering coverage changes from year to year. You can view all of the carriers offering major medical policies on healthcare.gov, but you can also apply directly through the carriers' website.

Q:What's the difference between applying on healthcare.gov vs directly through the insurance carrier?
A:

If you think you may qualify for a subsidy you will need to enroll through healthcare.gov. If you don't qualify for a subsidy it can be easier to enroll directly through the carrier's website or by phone. Healthcare.gov allows you to see multiple carriers' plans at once but the application process can be more cumbersome. Additionally, some plans/networks may only be available directly through the carrier and not visible on healthcare.gov.

Q:What networks are available?
A:

There are many different networks to select from. It is important to check that your current doctors accept the network you are looking to enroll in to ensure you won't have to switch to a different provider. You can do so by contacting your doctor's office or your insurance carrier.

Q:What does it cost?
A:

The different health plans will meet a variety of needs and budgets. Some health plans will have lower monthly premiums and may charge you more out-of-pocket when you need care. Some will be higher-premium plans that cover more of your costs when you need care. Others will fall in between. All plans will cover the same list of essential health benefits.  Based on your family’s income, you may be eligible for federal premium tax credits or additional cost-sharing reductions to help cover the cost of insurance. If you don’t have coverage in 2014, you may have to pay a fee. You can receive quotes for yourself or your family by going to healthcare.gov or calling an insurance carrier directly.

Q:When are the new plans available?
A:

Individual/family policies automatically renew January 1st every year regardless of when you enroll. Rates for next year will be available through healthcare.gov and insurance carriers November 1st.

Q:Who is eligible for subsidies?
A:

Subsidy eligibility depends on your family's total estimated yearly income. Click here to find out if you are subsidy eligible.

Q:How much will my subsidy be?
A:

The amount you save depends on your family size and income. The lower your income, the higher your savings.

Q:What are the penalties for not having coverage?
A:

The penalty is the greater of a flat dollar amount per uninsured person OR a percentage of taxable household income. By year, those amounts are:

  • 2014, $95 or 1 percent
  • 2015, $325 or 2 percent
  • 2016 and beyond, $695 or 2.5 percent

For children under 18, the penalties are half the adult amount. Beginning in 2017, the flat dollar amount will increase along with the cost-of-living adjustment. The flat dollar penalty is capped at 300 percent.  Overall, the annual penalty is capped at an amount equal to the national average premium cost of a Bronze-level plan, which means you won’t be penalized at a rate higher than it would cost you to buy insurance. 

Q:Is anyone exempt from paying penalties?
A:

A penalty will not be assessed on someone who:

  • Cannot afford coverage, meaning that the required contributions are 8 percent or more of gross income
  • Has income below the federal income tax filing threshold
  • Belongs to an American Indian tribe
  • Had a gap in coverage of less than three months
  • Resides outside the U.S. or is a bona fide resident of any U.S. possession

Individuals may also be granted hardship waivers or be exempted on the basis of their religious beliefs.