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Major Medical Health Insurance

Health insurance coverage is crucial for individuals and families because it provides financial protection against the high costs of medical care. Without insurance, individuals may face substantial out-of-pocket expenses for routine check-ups, prescription medications, emergency treatments, surgeries, and other healthcare services. Health insurance helps mitigate these costs and ensures that people can access the care they need without facing excessive financial burdens.

Here are some key reasons why major medical health insurance coverage is necessary:

  • Access to healthcare: Health insurance allows individuals to access a wide range of healthcare services, including preventive care, diagnostics, treatments, and medications. It ensures timely medical attention, which can prevent conditions from worsening or becoming chronic.
  • Financial protection: Medical expenses can be incredibly costly, especially for major procedures or long-term treatments. Health insurance helps individuals bear the financial burden by covering a significant portion of the costs, such as hospital stays, surgeries, and specialized treatments. This prevents individuals from facing crippling medical debt or bankruptcy.
  • Preventive care: Health insurance often covers preventive services like vaccinations, screenings, and annual check-ups. These preventive measures can help detect health issues early on and address them before they become more serious and expensive to treat.
  • Network of providers: Insurance plans typically have a network of healthcare providers, including doctors, hospitals, and clinics, with whom they have negotiated rates. Being insured allows individuals to access these in-network providers at lower costs. Moreover, insurance plans may offer specialized networks for certain conditions or access to renowned medical institutions.


Now, let’s discuss premium subsidies and how they work through the Affordable Care Act (ACA).  The ACA aims to make health insurance more affordable and accessible for individuals and families. One of the ways it accomplishes this is through premium subsidies and premium tax credits.

Premium subsidies are financial assistance provided by the government to help eligible individuals and families pay for their health insurance premiums. The subsidies are based on income and are designed to ensure that insurance coverage remains affordable.

Here's how premium subsidies work under the ACA:

Eligibility: Subsidies are available to individuals and families whose household income falls between 100% and 400% of the Federal Poverty Level (FPL). The exact income thresholds may vary based on the state and family size. Alaska has a higher threshold due to the high cost of healthcare here.

  • Marketplace enrollment: To qualify for premium subsidies, individuals need to enroll in a health insurance plan through the Health Insurance Marketplace, either the federal or state-run exchange.
  • Subsidy calculation: The amount of subsidy an individual or family is eligible for is determined by their income level and the cost of the second-lowest silver plan in their area. The subsidy is calculated as the difference between a benchmark premium (based on the second-lowest silver plan) and a certain percentage of the household income. The percentage of income required for premium payments increases with income level.
  • Application of subsidies: Once eligible individuals or families select a health insurance plan through the Marketplace, the subsidies are applied directly to their monthly insurance premiums. This reduces the amount they must pay out of pocket.


It’s important to note that premium subsidies are just one aspect of the financial assistance provided by the ACA. The law also includes cost-sharing reductions (CSRs), which lower out-of-pocket costs like deductibles, copayments, and coinsurance for eligible individuals with incomes between 100% and 250% of the FPL. These reductions are separate from the premium subsidies and further enhance the affordability of healthcare for eligible individuals.

Overall, premium subsidies through the Affordable Care Act help make health insurance more affordable for individuals and families, enabling them to access vital healthcare services while minimizing the financial strain.