How To Shop For Private Insurance
If youre not covered through your employer, or not eligible for financial assistance through a state-funded program, you will likely have to buy private insurance for individual or family through a private health insurance provider, such as Independence Blue Cross.
You may be able to purchase a plan on the Pennsylvania Insurance Exchange , which has replaced healthcare.gov.
Start by finding out which private health insurance carriers are available in your area. Independence Blue Cross serves the Philadelphia and southeastern Pennsylvania regions . See if private health insurance plans from Independence are available in your ZIP code.
Shopping for private health insurance is much easier when you know what questions to ask. When it comes to health coverage, everyone has different needs and preferences. We can help you figure out what type of plan you want, how to find a balance of cost and coverage, and what other benefits you should consider.
Who Should Choose A High Deductible Health Plan
A high deductible health plan is a plan that has a deductible greater than $1350 for an individual and greater than $2700 for a family. There are plans now with deductibles as high as $6000-$10,000. Thats a hefty sum of money to pay before your insurance will even kick in.
The benefit of the HDHP is the low premium, though these premiums are creeping higher every year.
Remember that even though you need to pay the deductible before your insurance will start paying, you also need to meet your out-of-pocket expenses before insurance pays 100%. Fortunately, you will likely pay around 20-30% of the cost for services once youve met your deductible.
High deductible health plans may be beneficial for you if:
#1 You and your family members are healthy and have low healthcare costs. There is some risk with this strategy, as you never know if you will need healthcare. A car accident, or a condition requiring surgery could arise, which can be quite expensive.
But for those that are young, have low risk jobs, and are relatively healthy, the risk may be worthwhile.
#2 You want to save money in a health savings account . You can then use this money as an investment or to pay healthcare bills when they become necessary.
With a lower premium, you will have more money to put into an HSA. And some HDHPs place money in an HSA for you as part of the plan. For individuals in 2019, the yearly amount you can put in a HSA is $3,500 and for families it is $7,000.
Do You Take Medications
Whether youre taking regular prescriptions or specialty medications, what they cost varies based on each plan. Check to see if the plan covers generic and brand name versions of the medication. Also make sure you receive your medications from a pharmacy thats in network, otherwise they may not be covered or you may pay more.
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Through The State Marketplace
The other way you can get health insurance is through your states Health Insurance Marketplace, thanks to the Affordable Care Act , which expanded health insurance access for uninsured individuals.
Getting insurance through the Marketplace can be more complicated than getting insurance from an employer. However, its a good option for some people, including those who are self-employed or unemployed.
Also, if you qualify for Medicaid in your state, which provides affordable health insurance for low-income individuals, you can only get insurance through the Marketplace. The same goes for families who qualify for a tax credit, or the Childrens Health Insurance Program .
To get health insurance through the Marketplace, you can visit HealthCare.gov and click the Take the first step to apply button. From there, you will be asked to input your state. If your state has its own insurance Marketplace, you will be redirected to that website. Otherwise, you will be brought to the federal health insurance website.
So, what are the pros and cons of private insurance through the Marketplace? The biggest advantage is that you have the widest range of plan options and providers to choose from. Unlike group health insurance, you probably wont be limited to just two or three options.
Heres what you need to know about these eligibility periods:
Get coverage during Open Enrollment
Get coverage after a Qualifying Life Event
Common examples of Qualifying Life Events include:
Why I Chose A More Expensive Plan
Its tough to tell which doctors are being left out of the smaller network you can look up individual clinicians or facilities, but its impossible to get a more holistic view of whos in and whos out.
Ive heard enough horrorstories about people getting five- and six-figure bills for care their insurance didnt cover, and the data backed up my concern that its a really big problem. While nothing short of a change in federal law can stop that from happening entirely, I figured that picking a plan with some out-of-network coverage could help .
Dahlia Remler, a health economist at the City University of New Yorks Baruch College, has also why out-of-network coverage can be important if youre sick, based on her own experience trying to find a neurosurgeon to treat a rare kind of tumor.
For what its worth, both Anderson and Tom Loach, the director of carrier relations at the insurance-shopping site eHealth, told me Id probably be fine with the more limited coverage.
“You really cant make a bad decision because youre not going to use it anyway,” Loach said.
Still, I figured Id opt for better protection. So Im spending about $1000 a year for the “Low PPO” plan.
Hopefully, when next year comes around, I still wont be going to the doctor much, and that thousand dollars will have been money wasted.
But I know theres a small chance itll have been well worthwhile. Who knew that healthcare could be so complicated?
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Income Tax Calculator: Estimate Your Taxes
Assume, as an example, that you are the only person on your plan. The premiums are $1,500 a year, your deductible is $2,500 per year, your co-insurance rate is 20% and your out-of-pocket max is $6,000. If you spend $2,000 on medical costs, your total out-of-pocket costs will be $3,500: $1,500 for premiums and all $2,000 of expenses since you will not yet have met your deductible.
Assume, instead, you spend $7,000 on medical expenses. Your total costs would be $4,900: $1,500 for premiums, $2,500 to meet your deductible, and 20% of the remaining $4,500 costs, or another $900.
If costs are higher than $7,000, you would continue to pay the 20% co-insurance amount until you had paid the out-of-pocket maximum of $6,000 on top of your premiums.
Tax-Saving Health Insurance Features: FSAs and HSAs
Health insurance plans often come with the option to use either a flexible spending account or a health savings account . Contributions to either of these accounts will reduce the amount of your income that is subject to federal and state tax but that is where their similarities end.
In most cases, the healthcare plan you choose will determine if you can use an FSA or HSA. You typically cant use both, except in cases where you elect to fund a limited-purpose FSA along with an HSA and HDHP. These kinds of FSAs can only be used for limited expenses like dental and vision and are allowed to be combined with the use of an HSA.
Who Is This Plan Best For
HMOs may be best for healthy individuals who don’t go to the doctor often and are looking for a budget-friendly health insurance plan.
Exclusive provider organizations s are similar to HMOs. They’re a smaller type of health insurance plan that limits coverage to the sole use of doctors, specialists, or hospitals in the plans network.
When Can I Buy Private Health Insurance
Most types of health insurance have an open enrollment period during which you can sign up for private health insurance. This is true whether you buy insurance via the Affordable Care Act health insurance exchange in your state, sign up directly through the insurer, enroll in the plan that your employer offers, or sign up for Medicare.
Certain life events can trigger a special enrollment period, which will allow you to change your health insurance coverage outside of the normal enrollment period. These events include getting married or divorced, having a baby, losing your job-based health insurance, or moving out of your health plans service area.
How To Get Cobra
Group health plans must give covered employees and their families a notice explaining their COBRA rights. Plans must have rules for how COBRA coverage is offered, how beneficiaries may choose to get it and when they can stop coverage. For more COBRA information, see COBRA Continuation Coverage. The page links to information about COBRA including:
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If Im Interested In Alternative Therapies How Does This Plans Coverage Work
See a chiropractor? Planning to have your baby at home? Curious about acupuncture?
Different health plans treat alternative therapies different ways. In some cases, youll be covered the same as any other care. In other cases, youll only be covered a little or not at all. If this kind of care matters to you, take a close look at your plans benefits.
Related questions to ask:
- How much do alternative therapies or services cost?
- Is there any kind of cost-sharing for alternative medicine?
- Do I plan on using alternative therapies often? Am I comfortable using other treatments instead?
Gold Silver Bronze Or Catastrophic Coverage
The best way to shop for health insurance is to get a better understanding of the individual and family plans that are available. The Affordable Care Act requires all plans to be organized by the level of coverage they offer. Theres also a catastrophic coverage plan available for people under 30, or for those who qualify for a special exemption. All plans cover the same essential health benefits the difference is what you pay in monthly premium and out-of-pocket costs when you need care.
The following chart helps you decide what type of health plan is best for you based on how much you are willing to pay towards your premium each month, and the cost youll pay when you receive care. For example, a gold health plan may be best for you if you use a lot of health care services, are able to pay more in monthly premiums, and want to pay less when you receive care.
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Best For Health Savings Plan Option: Kaiser Permanente
Kaiser Foundation Health Plans
We chose Kaiser Permanente because it administers its own Health Savings Accounts , which can help you save for health costs on a tax-advantaged basis.
Kaiser offers its own HSA
ACA-compliant plans available for individuals and families
Several top ratings in J.D. Power’s 2021 U.S. Commercial Health Plan Study
Coverage only available in eight states and Washington D.C.
Kaiser began offering health insurance plans to the public starting in 1945 and has grown to become one of the nation’s largest not-for-profit health insurance providers. Kaiser serves 12.6 million members in eight states plus Washington D.C.
When you pair a high deductible health plan from Kaiser Permanente with a Health Savings Account , you get a convenient debit card that lets you cover eligible expenses with your HSA funds directly and without any added paperwork. Your HSA plan also comes with no hidden fees, and you can get the $3.25 monthly plan fee waived if you maintain an HSA balance of $2,000 or more.
Kaiser may also offer ACA-compliant plans in your area, so it’s possible you could apply subsidies you receive to make your premiums more affordable.
Where To Call For Help
Selecting a health insurance plan can feel overwhelming, but you dont have to do it alone. There are a few ways you can go about getting expert help.
- Contact the if youre choosing your own individual or family plan for answers to any questions and assistance with enrollment.
- If youre selecting a plan through your employer, ask your human resources department if they can offer you assistance.
- If HR cant provide the help you need, ask them to direct you to an insurance agent or broker who can guide you through the process from start to finish.
- You can also find an agent or broker yourself by searching for local organizations within your state or ZIP code.
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Purchasing A Health Plan Through An Insurance Aggregator
If you want to explore your plan options further, you can consider applying for health insurance through an insurance aggregator, like Policygenius.
The application process is similar youll input your location, income, and some other personal information, like your desired monthly budget and list of medications. Based on your responses, the aggregators algorithm will match you with a variety of plans that are best suited for your needs.
If youre purchasing health insurance on your own for the first time, using an aggregator can simplify the process tremendously. Youll spend less time comparing plans individually, reading the fine print, and calculating the out-of-pocket costs, like you would with a Marketplace plan.
However, the downside of using an insurance aggregator is that you might not get access to the same range of plans you would get through the Marketplace. For example, if you are interested in an EPO plan, a site like Policygenius might not offer that type of plan in your area.
What Is Health Insurance
Health insurance is a plan that covers your medical expenses for preventative health screenings, illnesses and injuries, procedures, prescriptions and more. Oftentimes, you can enroll in a plan through your employer, but there are individual health insurance plans available as well that you can select and pay for yourself.
Health care can be confusing and expensive, but having health insurance coverage can help you avoid surprise medical expenses in emergencies or unexpected accidents. It can also lower the cost of your prescriptions, surgeries and routine doctor visits, as well as provide peace of mind.
When selecting a health insurance plan, Its important to understand all your available options before making a decision. Heres a breakdown of things to consider when determining the best health insurance plan for you.
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Are Health Insurance Premiums Tax
Yes. In Canada, health insurance premiums that you pay yourself are often eligible for a tax deduction under the Medical Expense Tax Credit. Premiums paid into a private insurance plan count as qualifying medical expenses assuming that 90% go towards medical expenses that are themselves eligible for the tax credit. Care like hospitalization, medical, dental, vision, and even medical devices are covered.
Plans paid by employers or provinces are not eligible for tax deductions.
Looking for a list of tax-deduction qualifying medical expenses?
This PDF from the Canada Revenue Agency details them:
Does The Plan Offer Specific Programs Or Services That Could Be Of Value To Me
Some health insurance plans for people with diabetes may offer programs or services of specific interest to people with T1D. For example, some plans may include insulins on their preventive medication list. If you have a HDHP, this has a direct impact on your costs. Preventive medications, including insulin, will not count toward your deductible, so you can get these medicines at lower cost right away. Each plan manages medications differently, so it would be best to call the health insurance company and ask if it has a preventive medication list that includes your insulin.
Also, many insurance plans now offer programs at low or no cost to help people manage chronic conditions like type 1 diabetes. Some plans may include services like educational classes, health tracking wearables or tools available on your device, and support groups. Details can vary by plan and by state, but can be confirmed by calling the health insurance company.
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Tip #: Sign Up And Save
Health insurance offers medical and financial protection in case of a serious illness or accident. In addition to protecting your health, health insurance can help guard against financial hardship, debt, and even bankruptcy.
If you dont have health insurance through your employer, your spouse, your parents, or another source, you can sign up for private health insurance. In the past, people with preexisting medical conditions were often denied health insurance or charged extremely high premiums. Today, you can purchase private health insurance through the Health Insurance Marketplace regardless of your past or current health.
Signing up for health insurance is the most effective way to plan for a healthy future for yourself, your family, and your finances.
How To Choose The Best Health Insurance Plan For Your Family
Nov. 1 is the beginning of open enrollment the period when people can sign up for new health insurance plans in the health insurance marketplace created by the Affordable Care Act . Many private employers hold their annual enrollment periods at the same time. On this date, millions of people all over the country begin shopping for insurance.
It can be a complicated process. There are many factors to consider when choosing a health insurance plan, including the monthly premium, the out-of-pocket costs, and the network of available providers, such as doctors and hospitals. Even experts sometimes find it hard to sort it all out.
To make sense of it all, you need to tackle the job systematically. Work your way through step by step, beginning with a grounding in the basics of how health insurance and health insurance marketplaces work. From there, you can move on to comparing different types of plans, costs, and coverage.
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