What is a Qualified Health Plan?
Did you know that ICHRA money can only be used to purchase a Qualified Health Plan (aka a QHP)? This article walks you through everything you need to know.
Imagine you're shopping for a cool new gadget, and there's this special "seal of approval" that ensures it's not going to immediately break. Or perhaps you’re shopping for food, and you see that the product is “FDA-approved.”
That's basically what a is for health insurance. It's like a thumbs up from US government saying, "Yep, this insurance won't let you down."
The reason why ICHRAs can only be used to buy a QHP is to protect you and make sure that any plan that you buy meets the consumer protections outlined by the Affordable Care Act (ACA).
The key ingredients of a QHP:
·Minimum Essential Benefits: QHPs come with this rockstar lineup of 10 essential health benefits. We're talking everything from your usual doctor’s visits and meds to hospital stays and even mental health sessions. No more worrying if something is covered or not.
·Seal of Approval: Before an insurance plan can strut around calling itself a QHP, it needs annual approval from the Center for Medicare and Medicaid Services and your state government. Basically, it's the universe's way of saying, "This one’s legit."
·Standardized Coverage Tiers: QHPs are available in different coverage tiers – Bronze (60% of costs), Silver (70% of costs), Gold (80% of costs), and Platinum (90% of costs). These tiers are standardized across insurers so you can compare and contrast easier.
· No Crazy Bills: QHPs cap out-of-pocket expenses for the year. For 2024, that maximum is $9,450 for individuals and $18,900 for families. On top of that, insurers cannot limit how much coverage they provide. Meaning, if you need $1 million coverage, the QHP must provide it. And the maximum you’ll pay is $9,450 per year. So, even if life throws a curveball, you won't end up with a heart-stopping medical bill.
· Protection for ALL: QHPs cover pre-existing conditions and are not allowed. It’s also against the law for a QHP to charge you more in premiums if you have a pre-existing condition. So, past health issues won’t haunt your coverage or wallet.
Think of a QHP as the VIP of health insurances.
How do you know if your plan is QHP?
All plans presented in the Venteur ICHRA platform are QHPs.
Plans are also listed every year on Healthcare.gov or State-Based Health Insurance Exchanges(like CoveredCA). You can also purchase them directly from a participating health insurance carrier by visiting the “Individual and Family Plan” section of their website.
