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.
Choose The Right Policy
Health insurance plans come in different variants and each variant provides a specific type of coverage. So, the next step would be to zero in on the right policy for your family.
Here are the commonly available health plans
So, ideally, you can opt for one family floater policy covering yourself, spouse and dependent children. If you have dependent parents, you may opt for a separate senior citizen policy for them.
Even in case of dependent children, remember that the family floater policy would cover them till 23 or 25 years of age. Once your children cross this age, an independent health insurance plan would be needed for them in most plans.
Also, along with an indemnity health insurance plan for your family, a critical illness plan is also recommended. The policy would cover dreaded illnesses, which have become common in recent times, and give you a lump sum benefit to meet the expensive treatment costs. So, you can opt for a critical illness policy for complete coverage for the family.
Compare Health Insurance Plan Metal Categories
When youre shopping for a plan on HealthCare.gov or your state exchange, the plans are shown in four metal categories. No, not like Mötley Crüe. More like Michael Phelps. The plans are tiered according to how much they cost and what they cover: Bronze, Silver, Gold and Platinum. Keep in mind that if youre eligible for cost-sharing reductions under the Affordable Care Act, you must pick a Silver plan or better to get those reductions.4
It’s good to know that plans in every category provide some types of free preventive care, and some offer free or discounted health care services before you meet your deductible. The way it basically works is that Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs. As you work your way up through the Silver, Gold and Platinum categories, you pay more in premiums, but less in deductibles and coinsurance.
However, the extra costs in the Silver category can be minimized if you qualify for the cost-sharing reductions, so youll want to make sure youre getting the maximum value of those reductions when youre shopping for health plans. They can substantially lower your out-of-pocket health care costs,so get with one of our Endorsed Local Providers who can help you find out what you may be eligible for.
The table below shows the percentage that the insurance company pays and what you pay for covered expenses after you meet your deductible in each plan category.
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Know Open Enrollment Dates
This years open enrollment deadlines have changed, which will affect when your 2021 coverage will start:
- If you sign up for insurance between November 1 and December 15, 2020, your health insurance plan will go into effect on January 1, 2021.
- If you sign up between December 16, 2020 and January 15, 2021, your plan will not begin until February 1, 2021.
- And if you sign up between January 16, 2020 and January 31, 2021, your coverage wont start until March 1, 2021.
If you would like your coverage to start on January 1, 2021, you will have to plan accordingly. And keep in mind that if you miss open enrollment, you may have to wait a full year before you can sign up again.
Open Enrollment: How To Choose The Best Health Insurance Plan
Open Enrollment. Workplace of a doctor. Stethoscope on wooden desk
We are in the heart of open enrollment season for employer benefits like health, life, and disability insurance. If you work for a company that offers these valuable enhancements to compensation, youve probably been given a menu of benefits from which to choose and a short window of time to make your selections for the year ahead.
These choices may seem inconsequential, especially those that cost a couple of dollars per paycheck, but many company benefits serve as a critical financial lifeline when unexpected challenges arise. Here, well be focused on the most complex decision before you: health insurance.
This is undoubtedly one of the most important benefits employers offer but how do you know which healthcare plan is right for you? Affordability of premiums is a factor but its not as simple as choosing the option with the lowest premiums. To begin evaluating the best option for you, consider not only the premium costs but how much you are likely to pay on the deductible and co-insurance as well.
Premiums, Deductibles, Co-Insurance and Out-of-Pocket Maximums
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What Does A Deductible Do Anyhow
Your health-insurance company should also do a similar analysis for you, though it’s typically buried in the middle of a document that you get from HR or from the insurance company, called the Summary of Benefits and Coverage.
Above, you can see that the high-deductible plan has a big financial head start on the other options, because Insider offers it to employees for free theres no annual premium. And the company will give you a few hundred dollars to spend toward your medical care, too. The next-cheapest plan costs nearly a thousand dollars a year.
I should note that our high-deductible plan is actually pretty generous. It limits the total amount that you could end up spending on healthcare in a given year to about $3,000.
Above that, all your care is free. The main caveat is that the limit only applies to care that you get from doctors who are in-network with the insurance.
All in all, its a really good choice for a lot of people. Margaret Bowani, who oversees the health insurance here, told me that she picked it for her own family and that its also popular with a lot of the companys younger employees.
Ashish Jha, a physician and health-policy researcher at Harvard, has written about his own experience using a high deductible plan for his family. Id definitely recommend reading his article before going with a high-deductible plan.
Four Steps To Choosing A Health Insurance Plan
9 Min Read | Oct 22, 2021
Do you know when the most wonderful time of the year is? No, its not the holidays. Were talking about open enrollment season, baby! Thats right! Its the magical time of year when you get to compare health insurance plans to see which one is right for you!
Okay, you got us. Probably nobody gets that excited about comparing health insurance plans. But when its time to choose, its important to know what each plan covers, how much it costs, and where you can use it.
This stuff can be complicated, but youre in the right place. We put together some practical learning steps for you so you can feel confident about your options.
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How To Get Help Choosing An Individual Health Insurance Plan
Whether you’re enrolling in an individual health plan for the first time or looking to switch your current benefit, choosing an individual health insurance policy on your own can be difficult. Many individual health insurance plans are available on the market, but how do you know which one is right for you?
Choosing a health insurance plan doesn’t have to be complicated or time-consuming. Nowadays, several innovative organizations are dedicated to helping individuals compare health insurance policies, answer questions and concerns, and virtually sign up customers for their benefit plan.
To give you a better idea, lets go over everything you need to know about individual health insurance plans and the companies that provide resources to help you choose the right one.
What Is An Individual Health Insurance Plan
An individual health insurance plan is a policy that individuals or families purchase on their own, not through an employer . You can buy individual health plans directly from a health insurer, a broker, or a state or federal health insurance exchange, also known as a marketplace.
When buying your own individual plan, you have more control over plan design and level of coverage. They can be tailored to fit you and your family more closely to ensure youre getting your specific healthcare needs met. And in comparison to employer-sponsored group health plans, many individual policies tend to be more manageable in cost.
In addition to health insurance, supplemental health plans, such as dental, vision, and disability insurance can be purchased on an individual basis. Employers do not typically provide these types of plans, so theyre chosen and paid for directly by individuals. Because individual plans arent tied to businesses or employment, you can keep your policy for as long as you want.
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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.
How To Choose A Health Insurance Plan
Deborah Fowles was a financial planning and budgeting expert for The Balance who spent over a decade contributing her expertise. She worked in a variety of fields prior to diving into writing, including pathology and marketing. In addition to publishing two books about personal finance, she wrote poetry, for which she won the Poetry Guild’s Award for outstanding poetry composition in 1997.
Health insurance plans are often offered through a group plan via your employer or your other family member’s employer, such as your parent, spouse, or partner. Other plans are available for purchase directly from an insurance company, the Health Insurance Marketplace, or through COBRA coverage.
If you’re married, single, a parent, young, or old, health insurance can help protect you against financial disaster in the event of a serious illness or accident. Whether you choose a group plan or an individual plan, there are important choices to be made that will affect not only the quality of your medical care coverage but also your wallet.
Review some of your options below so that you can make an informed decision that fits both your specific health care needs and your budget.
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Choosing A Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
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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Compare Health Insurance Plan Total Costs
When you choose your health insurance plan, its super important to pay close attention to other costs besides your monthly premium.
Other costs, often called out-of-pocket costs, can add up quickly. Things like your deductible, your copay, your coinsurance amount and your out-of-pocket maximum can have a big impact on the total cost. Here are some expenses to keep close tabs on:
- Deductible the amount you pay before your insurance company pays anything
- Copay a set amount you pay for things like doctor visits or other services
- Coinsurance – the percentage of health care services youre responsible for paying after youve hit your deductible for the year
- Out-of-pocket maximum the annual limit of what youre responsible for paying on your own
What Is The Affordable Care Act
The Affordable Care Act provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:
You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans.
Insurers can’t refuse coverage based on gender or a pre-existing condition.
There are no lifetime or annual limits on coverage.
Young adults can stay on their familys insurance plan until age 26.
Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.
Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.
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But Dont Focus Entirely On The Cost Of Claims
On the other hand, dont let yourself get so enamored with the low out-of-pocket expenses on the more robust plans that you inadvertently end up paying more than you need to. We often see plan comparisons where the difference in premium is greater than the difference in potential out-of-pocket savings.
For example: a plan with a deductible that is $1,000 lower than a competing plan, but that costs $100 more per month and offers similar coverage after the deductible. Buying it would mean that youd spend an extra $1,200 in premiums, to possibly save $1,000 if you have a significant claim. Thats why its important to spend a little time crunching numbers before you select a plan.
And if one of the plans youre considering is HSA-qualified, dont forget to account for the tax savings youd get if you contribute to an HSA during the year. Assuming youd be willing and able to make contributions to an HSA, youd want to subtract the tax savings from the total amount that each plan is going to cost you, so that you can get an accurate overall picture of how each plan would affect your finances.
Buyer Beware: New Cheaper Insurance Policies May Have Big Coverage Gaps
“Unfortunately, there are a lot of con artists out there who take advantage of the fact that people recognize health insurance is something that they should get,” says Corlette. She tells people: “Just go straight to Healthcare.gov. No matter what state you live in, you can go through that portal.” Any plan you find there will cover the ACA’s 10 essential benefits such as free preventive care and hospital coverage.
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Check The Provider Networks
Write down all the providers you think you or your family may use in the next year: physicians, specialists, and even specific hospitals, clinics or pharmacies. During open enrollment, review each plan youre considering to see if your preferences are included.2
Keep in mind, medical professionals and insurance companies are continually updating their contracts. Doctors or other professionals that were in-network last year may be out-of-network next year.
What To Consider If You Are
Turning 26 soon: If you are aging out of insurance coverage soon, its important to think ahead so youll know how to access a new health plan. Do you have a job that offers health insurance, or will you need to look into a Health Insurance Marketplace plan? If you see a certain doctor or have specific medications covered under your parents plan, youll want to look into plans that cover the same things or have the same network coverage. If you dont, then consider a high deductible health plan, which can be a lower-cost option that can meet your basic health needs.
In the process of family planning: If you are in the process of family planning, its helpful to compare fertility prenatal and postnatal service coverage, as well as delivery and inpatient services. This is another opportunity where picking a plan with a lower deductible or out-of-pocket maximum can make sense, as your insurance would contribute more to provider costs sooner. Once again, paying higher monthly premiums upfront means paying less later for services.
Another important note for any parent is that not only will your children have health coverage, but basic pediatric dental and vision for your little ones will also be covered by your medical plan. In addition, most health plans only charge monthly premiums for the first three children under the age of 21 or 19, depending on the carrier. This means if you have four or more kids on the plan, your monthly premium costs will effectively be capped.
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