Try To Find A Deal On The Deductible
The deductible is the amount you have to pay before your insurance kicks in. Different plans have different levels, and some may require you to pay a full $0 up front. If youre a low-risk individual, you may be able to find a deal on this level. But for those with higher risk , a lower deductible may be a better option. Because the deductible kicks in after you start receiving benefits, you dont have as much coverage to begin with. So while you may end up paying less overall, the difference is due to the fact that you started with less coverage.
How Buying Private Health Insurance Works
Some Americans get insurance by enrolling in a group health insurance plan through their employers.
Medicare provides health care coverage to seniors and the disabled, and Medicaid has coverage for low-income Americans.
Medicare is a federal health insurance program for people who are 65 or older. Certain young people with disabilities and people with end-stage renal disease may also qualify for Medicare. Medicaid is a public assistance healthcare program for low-income Americans regardless of their age.
If your company does not offer an employer-sponsored plan, and if you are not eligible for Medicare or Medicaid, individuals and families have the option of purchasing insurance policies directly from private insurance companies or through the Health Insurance Marketplace.
Guide To Purchasing Health Insurance
Individual or group coverage:
Group health insurance may be offered by employers, associations or purchasing pools. Group insurance may also cover the employees family members. Often the employer covers part of the premium costs. Employees will usually need to work a minimum number of hours to qualify for employer based group insurance.
Under the federal Affordable Care Act , companies with 50 or more employees will be assessed a penalty starting in 2015 if they do not offer group health insurance to fulltime workers. Companies with fewer than 50 employees are exempt from the penalty.
Businesses with fewer than 50 employees will be able to buy coverage through the Small Business Health Options Program on the new health insurance marketplace known as MNsure. Go to MNsure to look for small employer plans
Companies with fewer than 25 employees, average pay of less than $50,000, and that pay half the cost of insurance for their employees, are eligible for a tax credit in 2014.
Grandfathered or new:
Health insurance marketplace
Help shopping and choosing a health plan is available via navigators, in-person assisters, certified application counselor and licensed insurance agents/brokers, and via the MNsure customer call line at 1-855-366-7873. For more details about MNsure, go to MNsure.
Go to MNsure to see what plans are available and how to enroll.
80% in individual and small group markets
85% in large group markets
Short term coverage
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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.
What Is Open Enrollment
Plans available on HealthCare.gov are restricted to an open enrollment period.
To keep things organized, health insurance providers limit when you can sign up for their plans.
This means that if youd like to switch from your current insurance to something new on the marketplace, you may have to wait.
Typically, open enrollment for Obamacare happens around November each year. This window lasts about 6 weeks.
If you sign up during this time, your health coverage will kick in on January 1 of the next year.
Because open enrollment dates may change each year, you should always confirm when open enrollment begins.
If you purchase insurance directly from an insurance company, you dont have to wait at all! You can purchase these plans any time of the year.
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What You Should Know
- Advance Premium Tax Credits
An APTC is a federal tax credit that is used to lower the monthly cost of a Marketplace health plan. Eligibility for an APTC is available for those with a household income between 100 percent to 400 percent of the federal poverty level. The federal poverty level is adjusted annually. The Marketplace will determine your eligibility for an APTC.
If you are eligible and use a Marketplace APTC to lower your monthly premium payment, you will have to reconcile the credit when you file your federal taxes. For additional information and a step-by-step guide to reconciling your APTC, visit www.healthcare.gov.
- Cost-Sharing Reductions
CSRs allow you to save money when you receive health care services. A health plan with a CSR lowers the amount you have to pay for out-of-pocket costs like:
- Out-of-pocket maximum
To qualify for a CSR, you must purchase a silver level health plan on the Marketplace and have a household income between 100 percent to 250 percent of the federal poverty level. The federal poverty level is adjusted annually.
Not all health insurers choose to participate in the federal Marketplace. Prior to selling plans on the Marketplace, an insurer’s qualified health plan and rates must be certified by DIFS and the federal government.
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Ways To Buy Health Insurance
Most of us get health insurance from our employers. In fact, over 150 million Americans get health insurance for themselves or their family from an employer sponsored health plan. Employers are able to negotiate bulk rates by getting coverage for an entire organization at once.
If you dont get health insurance from your job, there are four primary ways to buy healthcare.
Your Options If Youre Not Eligible Through Your Employer
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If your employer doesnt offer you health insurance as part of an employee benefits program, you may be looking at purchasing your own health insurance through a private health insurance company.
A premium is the amount of money that an individual or business pays to an insurance company for coverage. Health insurance premiums are typically paid monthly. Employers that offer an employer-sponsored health insurance plan typically cover part of the insurance premiums. If you need to insure yourself, youll be paying the full cost of the premiums.
It is common to be concerned about how much it will cost to purchase health insurance for yourself. However, there are various options and prices available to you based on the level of coverage that you need.
When purchasing your own insurance, the process is more complicated than simply selecting a company plan and having the premium payments come straight out of your paycheck every month. Here are some tips to help guide you through the process of purchasing your own health insurance.
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Dont Be Afraid To Ask For A Discount
Shopping for health insurance on a budget shouldnt be treated as a black and white process. There are many shades of grey, and if you ask around, you may find that some insurers are willing to take a loss in order to protect their clients. If youre in a small town and youre able to get a discount on your first visit to the doctor, or on your first month of coverage, thats a splurge you can live with. Shopping around for insurance can also help you save on administrative fees, which can run as high as 30% of your policy.
Consider Whether You Want A Referral System Of Care
Plans that require referrals
If you choose an HMO or POS plan, which require referrals, you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Because of this requirement, many people prefer other plans. However, by limiting your choices to providers they’ve contracted with, HMOs do tend to be the cheapest type of health plan.
A benefit of HMO and POS plans is that theres one primary doctor managing your overall medical care, which can result in greater familiarity with your needs and continuity of medical records. If you do choose a POS plan and go out-of-network, make sure to get the referral from your doctor ahead of time to reduce out-of-pocket costs.
Plans that don’t require referrals
If you would rather see specialists without a referral, you might be happier with an EPO or a PPO. An EPO may help keep costs low as long as you find providers in-network this is more likely to be the case in a larger metro area. A PPO might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out-of-network.
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How Do You Shop For Health Insurance
Let’s get this out of the way: Shopping for health insurance could hardly be considered the top of anyone’s list of favorite activities. It’s more often likened to the misery of a root canal without anesthesia, a blind date with a man who gets salad dressing all over his face, or that dream where you have to give a presentation but you’ve forgotten both your notes and your clothing. Shopping for shoes, books and private yachts is fun shopping for health insurance is not.
But don’t despair. The good news about shopping for health insurance is that it’s getting much, much easier. And while we can’t promise that investigating premiums and comparing networks of doctors will ever be as much fun as a barrel full of monkeys, we can say that putting in the work of buying insurance is far preferable to dealing with sky-high medical bills. It’s also a task worth getting used to in 2014, carrying health insurance becomes a requirement, thanks to the Affordable Care Act. At that point, though, there will be exchanges set up where you can do one-stop comparison shopping. Until then, the process will take a few more steps, which we’ll walk through in this article.
Getting The Right Coverage Is Essential
This is a lot of information — but now you have a complete and comprehensive guide to buying health insurance and can make sure you and your family are protected. You can’t afford to compromise on your health, so take the time to find the best policy for your situation during your next open enrollment period. If health problems hit your home, you’ll be very happy you’re covered.
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What Is The Marketplace
The Health Insurance Marketplace®, or Exchange, is an online shopping center based at HealthCare.gov . It’s where to go to apply for coverage, find out if you qualify for savings, and make changes to your health plan.
Visit http://www.healthcare.gov/get-coverage to find out if your state uses the federal Marketplace or a state based Marketplace.
If your employer offers health insurance coverage, they may have a website where you can shop for plans. This is called a “private exchange,” and it’s different from the Federal or State Marketplaces.
The Marketplace makes it possible to find health care coverage that meets your needs and budget.
During the Open Enrollment Period, you can view, compare, and apply for Cigna individual medical plans online directly through Cigna. You can also see if you are eligible for federal financial assistance and apply that assistance to your Cigna plan.
Dropped By Your Existing Insurer
Although the Affordable Care Act prevents insurers from canceling your coverageor denying you coverage due to a preexisting condition or because you made a mistake on your applicationthere are other circumstances when your coverage may be canceled. Its also possible that your insurance may become so expensive you cant afford it.
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What Is The Affordable Care Act
Its been a few years since the Affordable Care Act was passed into law. But its implications are still felt today.
The ACA made it possible to purchase health insurance directly through a government marketplace. These plans are backed by tax credits that can reduce the cost of insurance for many Americans.
The ACA mandates that insurance plans listed on the government marketplace cover 10 key points .
Each plan listed on the exchange is categorized as Bronze, Silver, Gold, and Platinum. These categories are distinct in what they cover and how much they cost.
Types Of Health Plans
Because there are many different types of health plans, you should be sure to look for the one that fits your needs. Comprehensive health insurance provides benefits for a broad range of health care services. These health plans offer a detailed list of health benefits, may limit your costs if you get services from one of the providers in the plans network, and typically require co-payments and deductibles.
Here are some of the types of plans offered in Massachusetts
Health Maintenance Organization
HMO plans cover hospital, medical and preventive care. You are only covered if you get your care from HMO’s network of providers . With most HMO plans you pay a copayment for each covered service. For example, you pay $30 for an office visit and the HMO pays the rest of the cost.
Preferred Provider Plans
Preferred provider plans usually cover hospital, medical and preventive care. These plans have a network of preferred providers that you can use, but they also cover services for out-of-network providers. PPP’s will pay more of the cost if you use a provider that is in the network. Example: After copays and deductibles, the plan pays 100% of a service for a network provider but 80% for an out-of-network provider. Note that if you choose to go OON when you are in a PPP, your provider may balance bill you directly for the entire cost of the procedure.
Major Medical Plans/ Indemnity Plans
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How Much Does Private Health Insurance Cost
While many people are scared by the prospect of purchasing their own insurance versus enrolling in an employer-sponsored plan, some studies have shown that it can end up being more affordable than employer-sponsored plans.
A study from the Kaiser Family Foundation found that the average monthly premium for an employer-sponsored insurance plan for individual coverage in 2021 was around $645 and $1,850 for family coverage. If you were to purchase your own insurance outside of an employer-sponsored plan, the average cost of individual health insurance was $438. For families, the average monthly premium was $1,168.
In addition, if you end up purchasing coverage through the Health Insurance Marketplace, you may qualify for a Cost-Sharing Reduction subsidy and Advanced Premium Tax Credits. These can lower your premium payment amounts, your deductible, and any co-payments and co-insurance for which you are responsible.
Ways To Get A Health Plan
There are many different ways that you can buy a health plan in Massachusetts. Many people get their health plan through their place of employment. For people that can’t do this, there are several other ways to get a health plan.
Through Your Employer or Union
In Massachusetts over 70% of all employers offer health insurance as a benefit to their employees. Most of these employers pay part of the premium and also offer a choice of several health plans. You can choose the health plan that is best for you from the choices offered.
Qualified Student Health Insurance Plan
If you are enrolled as a student in a Massachusetts college or university, you can buy a health plan through your school. This SHIP id designed for students and is only available while you are enrolled.
Directly from an Insurance Company
Massachusetts residents can buy health plans directly from an insurance company. And the company can’t turn you down if you have a health condition. Sometimes the company will direct you to purchase their health plan through an intermediary. An intermediary is a company that takes care of the enrollment and premiums.
If you meet certain income requirements, you may be eligible for MassHealth. This is a Medicaid program paid for by the state and federal taxes for eligible persons. You can learn more at or call 1-800-841-2900
Through the Connector
Other Government Health Plans
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