ACA Marketplace Enrollment Solutions Provides Tips On How The Insured Person Can Use Supplemental Health Coverage To Avoid Steep Out-Of-Pocket Costs

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With more Americans entering the Healthcare Marketplace, in order to avoid financial hardship following a serious accident or illness, adding Supplement Health coverage needs to be explored by the insured.

News Image offers a variety of Supplemental Health coverage plans.

In a nutshell, our major medical insurance ensures that the doctors and hospitals get paid. Supplemental insurance ensures that you get paid your income if you can’t work due to an accident or illness

Robert Dial, Chief Compliance Officer, ACA Marketplace Enrollment Solutions ( explained, “Should you consider adding Supplemental Health benefits to your portfolio? Like most everything, it comes down to a financial decision. The twist with Supplemental, or sometimes termed Ancillary benefits, is that the financial decision not only involves what you can afford to pay each month for the insurance premium, but also determining what you can afford to lose, should you suffer a serious accident or illness.”

“According to the March U.S. Department of Health and Human Services, 89% of enrollees on the Marketplace selected either a Bronze or Silver plan for 2015. (1) Many of these enrollees, while perhaps receiving financial assistance with their premiums, may still face steep out-of-pocket costs throughout the year. This is where looking at adding Supplemental Health coverage might make financial sense,“ remarked Dial.

What Supplemental Benefits are, and what they are not:

  •     Supplemental Benefits are not major medical benefits (i.e., Blue Cross, Humana or United Healthcare)
  •     Major Medical Insurance, while very important, insures that the doctors and hospitals get paid. There is usually a co-pay and deductible associated with most insurance plans. After the deductible is met, the insurance kicks-in. Most policies then begin paying 80% of the covered expenses, while the policyholder is responsible for the leftover 20% of medical bills.
  •     For a serious accident or illness (cancer, heart attack, stroke, serious car accident, etc.), the healthcare bills can easily be in the tens of thousands of dollars with the 20% plan (or even 10% if you’re on a pricier plan) for which the policyholder is responsible for payment. Some policies have an out-of-pocket maximum, but that applies only to those things covered by the policy. Anything not covered is the policyholder’s responsibility.
  •     Supplemental benefits pay the policyholder CASH after an accident or illness. The cash can be used for whatever the policyholder chooses, including paying any leftover medical expenses
  •     For instance, many people may be surprised to learn of the high cost of treating cancer. Most families cannot afford their share of this type of expense. This is clear in a recent Harvard study where it showed that 62.1% of all bankruptcies in America were medically related. On top of that, the same study went on to state that 75% of those who went bankrupt had major medical insurance. (2)

Should I consider Supplemental benefits?

  •     The biggest factor in whether or not Supplemental benefits makes sense for a policyholder is: If a serious accident or illness were to happen, how long can the policyholder last without a paycheck before they would have to dip into savings or 401K plans?
  •     The facts are that most people are living off 100% of their income. If an individual make $50,000, they typically set up their lives to spend $50,000. Most individuals don’t anticipate a loss of income.
  •     If an employer offers Short-term disability, make sure to take advantage of this benefit. An individual can only get up to two-thirds of their income. However, remember, if you’re living off 100% of your income, decreasing to only two-thirds of your paycheck can eventually bring financial hardship.

The answer to whether or not an individual should consider Supplemental benefits is two-fold:
1.    Can you afford another $50-100/month out of you paycheck? A good agent will tailor-fit a supplemental plan that only costs 1 to 1.5 hours wage/week out of each paycheck.
2.    How long can you afford NOT have an income? If the answer to this question is under three weeks (or three months), then you should talk to your insurance agent about supplemental benefits.

Dial concluded, “Supplemental benefits should be looked at as an integral part of a financial portfolio as much as the healthcare portfolio. It prevents an individual from experiencing financial hardship, or even bankruptcy, following a serious accident or illness. In a nutshell, our major medical insurance ensures that the doctors and hospitals get paid. Supplemental insurance ensures that you get paid your income if you can’t work due to an accident or illness.”

(2) Himmelstein, MD, David. Thorne, PhD, Deborah. Warren, JD, Elizabeth. Wooldhander, MD, MPA, Steffie. "Medical Bankruptcy In U.S., 2007: Results of Nation Study." American Journal of Medicine Jan. 2009: 1 - 6. Print.

ACA Marketplace Enrollment Solutions ( is a national enrollment firm specializing in the Health Insurance Marketplace, Senior Product Market, and Voluntary Benefits. ACA Marketplace Enrollment Solutions is not affiliated with any governmental agency. We work with consumers to determine their subsidy eligibility, review benefits and plans that will meet their healthcare needs and get them enrolled for coverage. We offer opportunities for producers to have access to our carriers on a national level. Our Call Center is staffed with multi-lingual and licensed health insurance agents who also are certified on the exchange. The company’s website and our Call Center staff are available to assist enrollees through the entire enrollment process. Go to or contact 1-800-342-0631 for more information.

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