Information on Health Plans for Individuals
Optima Health is here to offer information on insurance options available for individuals.
Have you or someone you know:
- begun caring for ill or ailing family members
- experienced a change in income
- become self-employed, started working part-time or started a business
- lost a job
Whatever your need or situation, Optima Health has a solution for you. Eligibility for some plans are based on geographic location, age, income level, and other factors.
Coverage Options Available
In addition to possibly being eligible for COBRA1 or State Continuation, there are many options and resources available to you. If you have any questions, please call 1-800- 211-5417.
Individual and Family Plans
What it is: Private health insurance that individuals purchase, either through an online marketplace where they can compare prices (on Exchange), or directly from the insurance company (off Exchange).
Eligibility: While there is an annual enrollment period every fall, you may be able to enroll at other times during the year if you have recently lost job-based health insurance coverage, had a change in income, or another qualifying event. You have 60 days after a qualifying event to enroll in an individual & family health plan. Check to see if OptimaFit® Individual & Family plans are available in your area.
Benefits: All Optima Health plans offer comprehensive healthcare coverage and benefits for emergency care, virtual visits, inpatient stays, preventive care, doctor office visits, and more. Out-of-pocket costs will vary based on your plan and desired level of coverage.
Cost: Optima Health offers a wide variety of plans and premium rates to fit any budget. Plus, depending on your income, you may qualify to receive a government subsidy for plans sold on Exchange, meaning that your monthly health insurance costs (a.k.a. your premium) might be lower.
When coverage starts:
On Exchange: If the Marketplace approves your enrollment and you enroll by the fifteenth of the month, coverage will usually start the first of the month after you have selected a plan and made your first premium payment. If you’ve lost group coverage recently and you pick a Marketplace plan by the fifteenth of June, your new coverage starts July 1.
Off Exchange: If you enroll in an off-Exchange plan directly through Optima Health, your coverage will usually start by the first of the month after you have selected a plan and made your first premium payment. If you’ve lost group coverage recently and you pick an off-Exchange plan by the end of May, your new coverage starts June 1.
What it is: The Commonwealth of Virginia’s health coverage option provides free or low-cost health coverage for low-income families and children, pregnant women, the elderly, and people with disabilities. Coverage starts on the first day of the month in which you apply and are found eligible.
Eligibility: Based on income limits and varies depending on annual household income (before taxes).
Benefits: Just as with private insurance, Medicaid has different levels of benefits and services.
Cost: Little to no cost.
Family and Medical Leave Act (FMLA)
What it is: Allows eligible employees to take up to 12 weeks of protected unpaid leave for certain family or medical reasons, including dealing with a serious health condition of the employee or the employee’s immediate family.
Eligibility: Generally speaking, to be eligible to take FMLA leave, an employee must have worked at least 1,250 hours over the course of one year prior to taking FMLA leave and work at a location where there are at least 50 employees within a 75-mile radius.
Benefits: Your health care coverage would remain the same as before taking leave.
Cost: You would pay your regular employee contribution to maintain your health coverage.
Talk to your employer or benefits administrator for more information.
What it is: Medicare plans are available in two types: Original Medicare and Medicare Advantage plans. Original Medicare plans are offered by the Federal government while Medicare Advantage plans are offered through private health insurers. Coverage starts on the first day of the month after your application is approved.
Eligibility: You are eligible for Medicare if you are at least 65 years old, if you are younger with a disability and collect a disability income from Social Security, or have End Stage Renal Disease.
Benefits: Vary by plans, some of which include pharmacy, dental, and vision options.
Cost: Plans start as low as $0 monthly premium.
Other Options for Health Coverage
- Depending on the size of your company, you may qualify for COBRA1 coverage, which is generally available to former employees and retirees, as well as their spouses, former spouses, and dependent children if they were originally covered. Some states have expanded coverage, so if you’re not sure, ask your benefits administrator, or reach out to your state’s labor office.
- You may want to look into joining a spouse, partner or family member’s employee–sponsored plan.
- If you’re under 26, you may be able to join your parents’ employer–based plan.
- If you’re turning 26, and are no longer eligible to be covered by a parent’s plan or your employer, the Marketplace or Medicaid may be appropriate options for you.
- You have 30 days from the time your previous employer stops paying your insurance to enroll in your family member’s employer–based plan.
1 The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee. (healthcare.gov)