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Now is the time for small business owners or professional practices to decide what health insurance option is best for themselves, for their families, and for their employees.

October 1, 2023, is the date that new rates and options for Individual Health Insurance plans and for Affordable Care Act plans generally become available.  

November 1, 2023, is the beginning of Open Enrollment under Affordable Care Act (ACA) insurance and runs through January 15, 2024. That means you can alter your choice at any time until the January 15, 2024, deadline. However, to be effective for January 1, 2024, a plan must be selected by December 15, 2023. Neither dental care nor eye care is automatically included in individual, group, or ACA plans, but dental and eye care can both be added to any of those policies at an additional cost.

What are the advantages of group insurance?

  • Employer paid, fully or partially, often with tax-favored dollars
  • Ability to offer an essential benefit to employees
  • Streamlined administration
  • Potential to offer better, more creative plans such as HSA’s (Health Savings Accounts), HRA’s (Health Reimbursement Accounts), and Self-Insured Plans
  • It only takes two employees for a business to be eligiblefor group insurance
  • If employees aren’t getting or are not eligible to get government subsidies under the Affordable Care Act, group insurance is typically less expensive

How does an ACA individual plan differ from group healthcare plans?

Under the Affordable Care Act and under Individual Health Plans, the insured gets to choose between many different carriers and dozens of different plans. With group insurance, insureds have to go with the employer’s chosen carrier and often have a limited number of plans to choose from.

Employers usually choose to pay a portion or all of the premium on a group plan, while insureds under the Affordable Care Act or on Individual policies are typically responsible for their own premiums. However, under the Affordable Care Act, if an individual or family falls within a certain income level, they will qualify for a premium subsidy which can drastically lower their cost for high-quality health insurance. 

Who is coverage under the Affordable Care Act generally the best for?

  • Those not offered group insurance
  • Low-to-medium income level individuals and families

Who is coverage under Employer Group Insurance generally the best for? 

  • Employers and Professionals who want to provide cost and tax-effective benefits for their employees and for themselves
  • Employers and Professionals who want to include other benefit options, such as life, dental, vision, disability, or 401K for themselves and for their employees
  • Employers and Professionals under a plan in which the owners, key employees, or professionals get major benefits for themselves and their families that otherwise could not be obtained

Who is coverage under Individual Health Insurance generally the best for?

  • Individuals and families in good health who can answer health questions and do not qualify for a significant subsidy under the Affordable Care Act

Why should someone consider adding dental and vision insurance?

  • Many dentist and vision providers have different price models. If a patient has insurance that has been accepted by their dentist or eye doctor, the negotiated rates are generally less even when not fully covered by the insurance. 

With an MBA in Finance and over 50 years of experience in employee benefits, my associate, David Deaderick said, “As you can see from this information, the decision to choose between group, individual health insurance, or the Affordable Care Act is complicated. The same may be even more true when some of the participants are age 65 or over. Therefore, advice from a knowledgable person in this field is highly recommended.

For more information about healthcare insurance options or quotes, employers, professionals or individuals can contact Steve Lester at Felsenthal Health and Employee Benefits, (901) 268-4824; Steve@fhmemphis.com; or David Deaderick, (901) 260-6420; fpsc_dd@bellsouth.net; or go online to www.fhmemphis.com. Steve Lester is a Registered Employee Benefits Consultant under the National Association of Health Underwriters and a member of the ACA Marketplace’s Circle of Champions.