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How To Choose Health Insurance

Learn How To Save Money On Health Insurance

How to Choose the Best Health Insurance Plan | 5 Steps to Pick the Right Mediclaim Policy

One of the best ways to save money on health insurance is to use a high-deductible health plan , especially if you dont expect to regularly use medical services. Just like the name says, these are health plans with high deductibles.5 These plans have lower monthly premiums, but youll pay a lot more out of pocket for health care costs before your plan kicks in.

You can apply this high deductible/low premium strategy to any of the health insurance network plans we discussed earlier .

HDHPs can be combined with a Health Savings Account , which allows you to set aside money tax-free to pay for qualified medical expenses. You may be asking yourself, Wait a minute. Who determines just what they mean by high deductible?

Thats a great question. The IRS does. Thats who. And for 2021, the IRS defines a high-deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family.6 An HDHPs total yearly out-of-pocket expenses cant be more than $7,000 for an individual or $14,000 for a family.7

And the HSA is a great feature of HDHP plans because you can contribute up to $3,600 for an individual and $7,200 for a family tax-free for 2021.8 For 2022, you can contribute up to $3,650 for individual coverage and up to $7,300 for family coverage.9

Even better, this money rolls over if you dont use it, and you can even invest the money in your HSA so that it grows tax-free.Thats awesome! Being able to open an HSA is great for your future.

How To Access Health Insurance

Knowing what to look for as you choose your health insurance plan is one thing, but figuring out how to access it is another piece of the puzzle. The main options are to purchase a plan directly through the Health Insurance Marketplace, receive coverage through an employer, or enroll in either Medicare or Medicaid. Heres a brief look at each of those choices.

Look For A Summary Of Benefits

Online marketplaces usually provide a link to the summary of benefits, which explains all the plan’s costs and coverages. A provider directory, which lists the doctors and clinics that participate in the plans network, should also be available. If youre going through an employer, ask your workplace benefits administrator for the summary of benefits.

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Some Things To Look Out For

Choosing a health insurance plan can be complicated. Before you can buy an individual policy you must give the insurance company information about your health. This process is called medical underwriting. Knowing your rights and obligations during this process is essential.

As the cost of health care rises, health insurance scams are becoming more common. Watch out for unlicensed insurers that offer cheap coverage but then refuse to pay claims. Also be wary of so-called “discount health plans” that are not really insurance at all, but advertise in ways that make it sound as if they are. When in doubt, contact Wisconsin’s Office of the Commissioner of Insurance at 608-266-3585 or 800-236-8517 to confirm that you are working with a licensed insurer. Remember: if it sounds too good to be true, it probably is!

How To Enroll And Get Answers To Your Questions

How To Choose The Right Health Insurance Coverage

You can learn more about and apply for ACA health care coverage in several ways.

  • Visit HealthCare.gov to apply for benefits through the ACA Health Insurance Marketplace or you’ll be directed to your state’s health insurance marketplace website. vary by state.

  • Find a local center to apply or ask questions in person.

  • Download an application form to apply by mail

Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.

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How To Choose The Right Health Plan

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When were given a choice about our health care plans, we often choose badly.

In one study, more than 80% of the employees at a Fortune 100 company picked the wrong plans, often choosing low-deductible options that ultimately cost them more. Another study found that inertia sticking with the same plan, rather than evaluating the options each year and choosing a better one cost workers an average $2,032 annually.

These findings shouldnt surprise anyone who has tried to compare multiple health insurance plans offered by an employer, an Affordable Care Act marketplace or insurers with coverage that supplements Medicare.

But we owe it to our health and wallets to make the best choices we can during open enrollment. The following steps wont guarantee youll pick the best plan, but they may help you avoid the worst.

Whats The Difference Between Bronze Silver Gold And Platinum Health Plans

In addition to the types of health plans youll find in your search, youll probably see each plan has a designated metal: either bronze, silver, gold, or platinum. This doesnt necessarily mean you should only be looking at gold and platinum plans it actually represents how you and your plan split the cost of your healthcare. Heres what we mean:

  • Lowest costs when you need care

Note: deductibles are very low for platinum plans. But if you use a lot of care, nearly all your health costs will be covered in exchange for a high monthly premium.

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Things To Consider When Choosing Your Health Coverage

Choosing a health insurance plan can feel like an overwhelming task. Here are five things to keep in mind when choosing health coverage for you and your family. For specific information on plan components, see your plans Summary of Benefits and Coverage , call the insurer directly or visit the insurers website.

1. Type of Plan and Provider Network

Do the health care providers, hospitals and pharmacies you prefer fall within the plans network?

Its important to remember that in-netword services and medicines are covered under a plan, while out-of-network services and medicines may require additional out-of-pocket costs or may not be covered at all. Importantly, out-of-pocket costs for out-of-network services may not count toward a plans out-of-pocket maximum. Check to see if your preferred primary care or specialist provider and the pharmacy near your home are included in the plans network.

2. Premiums

How much will you pay per month for coverage?

Premiums are the amount you pay an insurance company for coverage, whether or not you use medical and pharmacy services. Premiums are usually paid monthly, and if you stop making payments, you are at risk of losing your coverage. Keep in mind that these are not the only costs associated with coverage. You will also be responsible for paying deductibles and for cost sharing, for example, co-pays and coinsurance, for most health care services and treatments.

3. Deductibles

4. Co-pay or Coinsurance

5. Coverage of Medicines

Factors That Drive Health Insurance Costs

How to choose a health insurance plan: The full breakdown

On an individual level, there are certain factors that affect health insurance costs. The predominant factors are:

  • Location: The state you live in or even your zip code can affect health insurance rates.
  • Age: Health insurance becomes increasingly expensive as you get older.
  • Smoking: The ACA permits insurers to charge smokers more for health insurance. The difference in cost between a smoker and non-smoker can be as high as 50%, although this amount often varies by state and some states prohibit the practice.

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How To Choose The Right Health Insurance Plan

Selecting health insurance is an important decision for everyone that requires careful consideration. As a quick overview:

  • The majority of people receive health insurance through their employer-provided benefits.
  • Those who are self-employed may have to purchase health insurance individually.
  • If you retire before age 65, you will need health insurance until Medicare begins.

With various options depending on your individual circumstances, choosing health insurance can often be an overwhelming process. Here’s how to choose the right plan for you and your family:

1. Select your plan type.

For many people, the most important factor is the cost of health insurance. HMO plans are the least expensive, offering a lower monthly premium and less out-of-pocket expenses for medical services. The designated primary care physician serves as the gatekeeper and determines when you may see specialists. Thus, the downside is that HMO plans are the most restrictive.

PPO plans charge a higher premium in exchange for greater flexibility in choosing your providers. You do not need a referral to see any specialist and may use out-of-network physicians. However, you will incur higher expenses, and you may have to file a separate insurance claim. For further information about the HMO and PPO plans, click here.

2. To determine which plan best fits your financial situation, consider how the following expenses may impact your budget:

3. Review the accessibility of your preferred doctors.

Tip #: Know Where To Go

It’s not always obvious where to look for health insurance. “In this country it is a truly wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.

If you’re 65 or older, you’re eligible for Medicare. It’s a federally run program the government pays for much of your health care. You might also be eligible if you have certain disabilities. For those already enrolled in Medicare or in a Medicare Advantage plan, the open enrollment period to switch up your supplemental health and prescription drug plans for 2022 runs through Dec. 7 this year.

For those under age 65, Corlette says, “the vast majority of us get our coverage through our employer. The employer typically will cover between 70% and 90% of your premium costs, which is pretty nice.” Check with your supervisor or your company’s human resources department to find out what, if any, plans are available to you through your job.

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What Should You Look For When Choosing Health Insurance

When choosing health insurance, it is important to consider your health needs at your current stage of life, along with any future health needs you may foresee, along with the current and future needs of anyone else who may be covered along with you on the policy, such as your partner or your children.

While health insurance is a matter of individual choice based on your needs and circumstances, there are some specific questions you might ask, about topics such as what inclusions the cover has, what excess youll have to pay, whether or not you want extras cover, and whether you wish to avoid the Medicare Levy Surcharge .

Gold Plans: A Better Value In Some Areas

How to Choose a Health Insurance Plan in 5 Easy Steps

Cost-sharing reductions were in the headlines throughout 2017, as the Trump administration repeatedly threatened to cut off funding for them, and then announced definitively in October 2017 that the funding would end.

But despite the elimination of funding, CSR benefits continue to be available. The Congressional Budget Office estimated that the elimination of CSR funding would increase average Silver plan premiums by about 20% in 2018, and most insurers did add the cost of CSR to their premiums. In most states, the cost of CSR was added to Silver plan premiums for 2018, but some states and insurers took other approaches.

Because premium subsidies are based on the cost of Silver plans , the majority of the premium increase to cover the cost of CSR is ultimately still being paid by the federal government, in the form of larger premium subsidies.

But due to the CSR funding cut, Silver plans in some areas now actually cost more than Gold plans, and some enrollees can qualify for premium-free Gold plans after their subsidy is applied. For people with income below 200% of the poverty level , the best choice is probably a Silver plan for 2022, as the out-of-pocket costs are much lower due to CSR, and the ARPs enhanced premium subsidies will offset much of the higher premiums.

But people with income above 200% of the poverty level might be better off with a Gold plan instead of a Silver plan if the premiums are quite similar .

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Comparing Health Insurance Plans: Hmo Vs Ppo Vs Epo Vs Pos

Plan type

Do you have to stay in-network to get coverage?

Do procedures & specialists require a referral?


Yes, except for emergencies.

Yes, typically.

Lower out-of-pocket costs and a primary doctor who coordinates your care for you, but less freedom to choose providers.

PPO: preferred provider organization

No, but in-network care is less expensive.

More provider options and no required referrals, but higher out-of-pocket costs.

EPO: exclusive provider organization

Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers.

POS: point of service plan

No, but in-network care is less expensive.


More provider options and a primary doctor who coordinates your care for you, with referrals required.

How Do You Get Health Insurance

Depending on your age, job status, and financial condition, there are many ways that you can get health insurance, including:

  • Health insurance provided by an employer. Large companies in the U.S. are required to provide affordable health insurance as an employee benefit , and many small employers also offer coverage to their workers. You will likely be required to pay some portion of the monthly premium, or cost of the health insurance, particularly if you add your family to your plan. But most employers that offer health coverage do tend to pay the majority of the premiums.
  • Health insurance that you purchase on your own. If you are self-employed or work for a small company that does not provide health insurance, you will need to buy it on your own. You can get it through the health insurance exchange in your state, or directly from an insurance company, but premium subsidies and cost-sharing subsidies are only available if you get your coverage through the exchange.
  • Health insurance provided by the government. If you are 65 or older, disabled, or have little or no income, you may qualify for health insurance provided by the government, such as Medicare or Medicaid. Children, and in some states, pregnant women, are eligible for CHIP with household incomes that can extend well into the middle class. Depending on the coverage and your circumstances, you may or may not have to pay monthly premiums for your government-sponsored health coverage.

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Medicare Advantage: What Does It Cover

Part C, meanwhile, is also known as Medicare Advantage. This is a program that combines Parts A and B, adds additional benefits , and typically includes prescription drug coverage .

Keep in mind that while using Medicare Advantage Part C, Part A and B do not go away and you are still responsible for those premiums.

Again, for a better understanding of what Medicare and its alphabet soup on letters cover, see this article.

How To Shop For Private Insurance

Health Insurance Basics: How Do I Choose the Right Plan?

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.

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Tip #: Know Your Deadlines

Usually you only get a few weeks in the fall to sign up. This year, the sign up period for the HealthCare.gov marketplace plans that go into effect in January 2022 starts Nov. 1, 2021 and runs until Jan.15, 2022. If you’re signing up for an employer-sponsored plan or Medicare, the deadlines will be different, but probably also in the fall. For Medicaid, you can enroll at any time of the year.

DeLaO, the health navigator, says even if you’re already enrolled in a plan that seems fine and it’s tempting to just let it automatically renew, it’s always a good idea to annually check what else is available.

“Are you eligible for additional subsidies to lower the cost of your monthly premium?” he says. “Is there a plan that with those increased subsidies you can now get a silver plan as opposed to a bronze plan, which lowers your deductible your copayments?”

Figuring out the right plan for you doesn’t have to require a huge time commitment, he says. His team aims to get people in and out enrolled in a plan in an hour and a half. And those appointments don’t have to be in person customers can get help by phone and can often do everything they need to do to get signed up virtually.

Though signing up for health insurance can be confusing at first, it’s also very important for your wallet and your health. Hang in there and know there are people out there eager to help you make sure you get covered.

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