Breland, LLC

Individuals & Families

Under Age 65

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You have no insurance or are paying too much. What are your options?

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​New private health insurance plans are available for individuals, families, and small business owners who do not want an ACA plan (aka Obamacare). Many of these new plans provide better coverage in most situations and potentially have lower premiums and fewer out-of-pocket expenses. Before explaining your options, you may benefit from a little historical background regarding the ACA.

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The "Affordable Care Act," or the ACA, requires all individual "Major Medical" health insurance policies to cover what the government deems "Essential Healthcare Benefits" (their words), such as routine maternity coverage, unlimited lifetime benefits, and no waiting period for covering pre-existing conditions. The ACA also requires all Major Medical policies to be guaranteed issue to all who apply during open enrollment. If you apply during open enrollment, you can’t be turned down for medical reasons.

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The ACA provides tax subsidies for people whose taxable earnings are within a specific range. Obamacare may be the best option for you if you are eligible for significant tax subsidies or are actively being treated for a major pre-existing condition such as cancer, but it’s advisable to supplement your ACA plan (if you can qualify medically) with an individual indemnity plan to help you with covering expenses that you ACA plan may not, such as high deductibles, copays, and out of network balanced billings. Breland Benefits and Insurance does not offer Obamacare plans but can connect you with our strategic partner to determine if you qualify for an ACA plan and subsidies. Click here for the form to complete and email me. Your information is safe.

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If you make too much or too little money (according to government officials), you may not qualify for full subsidies or any subsidies at all. Furthermore, if your income fluctuates significantly as is common among the self-employed, you could have to pay subsidies back on your next tax return if you underestimated your future annual income on your application. The opposite is true also, you may not qualify for subsidies, because you had a banner year last year, even though your current income falls perfectly within the subsidy guidelines. In short, ACA subsidies aren’t reliable for most self-employed persons and business owners.

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The good news is that the private sector recognizes the problem and has provided options to supply the demand for affordable, quality, private health insurance. Initially, the ACA penalized Americans who did not purchase Obamacare policies, but the penalty was eliminated with the passage of the Tax Cuts and Jobs Act of 2017, so there is no reason not to explore private health insurance options.

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Your choices fall into one of four categories, i.e., Employer/Association plans, Indemnity Plans, Faith Based Plans, and Short Term Medical Plans. Breland Benefits and Insurance is an independent brokerage agency that provides clients access to all four categories of health plans and to virtually every reputable insurance company, regardless of where you live in the USA. However, the following information may be helpful before discussing what we recommend.

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Employer/Association Plans can either be fully insured or level-funded.

Fully insured plans are available almost exclusively as employer-sponsored plans. Since this article is about those who aren’t eligible for group health plans, we will not discuss this option here other than to say that since employers typically subsidize the employee premiums, their decision to go with one plan over another is based on the lowest employee rate. Knowing this, insurance companies often skew premiums to keep the employee premiums low, shifting the higher premiums to the dependents. For this reason, you may get better value for your dependents in the private market. 

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Blue Cross and Blue Shield (BCBS) is an association plan for individuals fully insured (in the states I am aware of) and is ACA compliant. BCBS varies from one state to another, and some states reciprocate coverage with other state BCBS programs, but some states do not. BCBS is a PPO in some states and an HMO in others. Generally, BCBS will be more expensive than the private plans we at Breland Benefits and Insurance offer and often have more restrictive networks. Nevertheless, it is an option you should consider when comparing your options. Note: Breland Benefits does not offer BCBS individual plans, but we are affiliated with TPAs that can provide BCBS employer-sponsored group health plans.

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Association plans are typically level-funded, which used to be referred to as “partially self-insured plans.” This does not mean that you as a policyholder are self-insured, it means that your plan is administered by a Third Party Administrator (TPA) which adjudicates claims using funds pooled by the association members. If claims exceed the claims pool, a reinsurance policy will cover those claims. If excess funds are available in the claims pool at the end of the policy year, these funds can either be refunded to premium payers or used to keep premiums low for the next year. Association plans provide self-employed persons and small business owners with affordable options in 2024, but small business owners need to know that there is a huge risk difference between a level-funded association plan versus a level-funded group plan that underwrites your company as a group. Breland Benefits can help you with your decision-making.

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Indemnity Plans were exempted from ACA mandates because they were, and to some degree, are considered valuable supplemental policies. Indemnity Plans are contracts between the policy owner and the insurance company that state if X happens, the insurance company will pay Y. A life insurance policy, for example, is an indemnity plan that states if a covered person dies, the insurance company will pay X amount to the policy’s stated beneficiaries. Other indemnity insurance plans cover dental, vision, long-term care, and disability events. Some indemnity insurance plans pay benefits when covered persons are diagnosed with specific diseases or illnesses, and some pay when they have medical services at a doctor’s office or hospital. These plans should always pay the contracted benefits, regardless of the patient’s responsibility, even if the health claims were paid in whole or part by another source, such as another health insurance plan. Insurance companies began to develop more and more benefit-rich indemnity insurance plans to provide individuals with an affordable alternative to Obamacare. All health insurance plans have limitations, or holes, as I call them. Indemnity plans are no different; huge differences exist between the coverages these plans provide. As of the first quarter of 2024, there is only one indemnity plan that we at Breland Benefits would recommend as an alternative to Major Medical, and even in that case, we recommend bundling it with at least one other plan to protect in the event of catastrophic situations. Bundling some indemnity plans with an association, employer, or ACA plan can provide the best coverage available. It may sound too good to be true. You can watch a short video I created regarding the best bundle by clicking HERE.

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​The ACA also exempted faith-based plans as a compromise to the Christian Coalition with the caveat that such plans cannot be insurance since insurance companies may not discriminate based on religion. Therefore, faith-based plans cannot use insurance terms such as co-pay or deductible. Health insurance plan changes, including premium increases, must be approved by state insurance commissioners, but since Faith-Based plans are not insurance, they are not regulated by state insurance commissioners either. This means they can change policies, including what they will cover or how much they will bill you, at any time throughout the year. Some faith-based plans have moral codes, such as a requirement to attend a house of worship every Sunday or belong to a certain denomination. Some faith-based plans have unorthodox methods of determining if and how a claim should be paid. For these reasons, Breland Benefits rarely recommends Faith-Based health plans, and when we do, as for now, there is only one Faith-Based Health plan that we are comfortable recommending.  

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​Short-term medical (STM) plans such as Golden Rule (a United Healthcare company) are good for those who are in between jobs or will be eligible for Medicare before their policy expires, but STM plans should never be relied on exclusively in place of permanent insurance because they are not guaranteed renewable. Many agents sell temporary policies because they are generally less expensive and point out that should you be unable to renew your policy due to a medical condition, you can purchase an Obamacare policy during open enrollment on a guaranteed issue basis, regardless of pre-existing conditions. We at Breland Benefits don’t recommend this strategy because the risk is greater than the benefits of lower monthly premiums. Besides, those who can qualify for a STM plan can usually qualify for a guaranteed renewable plan with better benefits for about the same monthly premium.

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So, there you have it! Your options for individual health insurance in 2024, you can shop until you drop, or you can call me, Darryl Breland, at 601-624-2424 because I am always shopping the market and always recommend what I believe is best for you, even if it’s something that I don’t offer.