When shopping for health insurance, many consumers will find options for both types of health insurance. There’s public health insurance, which includes Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and private health insurance, which people choose through the federal marketplace or get from their employer.
Here’s a complete guide on how to get insured.
Essential Features of Health Care Plans
When choosing how to get insurance for just yourself or your entire family, you don’t want to rush the decision. Picking the wrong insurance can be costly. Whether you go through the federal marketplace or an employer, begin your search with a general understanding of the essential features of any health insurance plan.
- Premium: To access a health insurance plan, you must pay a premium every month to a health insurance company. The monthly premium doesn’t equate to how much you will pay for health care services, though — plans with higher premiums tend to have lower out-of-pocket costs.
- Deductible: The deductible is how much you’ll pay out-of-pocket for a covered health care service before your insurance starts to pay. Generally, lower premiums will have higher deductibles. After hitting your deductible, you’ll likely have to pay copayments and coinsurance until you reach the out-of-pocket limit.
- Copayment: Often referred to as a “copay,” a copayment is how health insurance companies split costs with consumers. Once you pay your deductible, you may still have to pay a fixed price for covered services until you hit the out-of-pocket maximum. Some copayments may even apply before you reach your deductible.
- Coinsurance: This is another way for health insurers and consumers to split costs. Whereas copayments are a fixed amount you pay for a specific service or prescription medication, coinsurance is a percentage of the price you’ll have to pay. Both must be paid until your out-of-pocket limit is reached.
- Out-of-pocket limit: The out-of-pocket limit is the maximum amount you’ll have to pay for covered services in a given year. When you pay your deductible or make any coinsurance payments and copayments, these actions apply to your out-of-pocket limit. Once you hit the maximum out-of-pocket amount, the plan will pay 100% of your medical expenses.
Who Benefits From Health Insurance?
Everyone can benefit from buying health insurance as long as they utilize the proper considerations. It’s no secret that medical bills and service costs are generally too high to cover on your own, meaning a severe health issue can easily cause financial disaster. Certain groups of people should make additional considerations when choosing a health insurance plan:
Many universities require that students have health insurance. A parent can keep their child as a dependent on their health insurance plan until they turn 26. If a student can remain on a parent’s plan, they may not need to buy health insurance for the school.
Specifically, students attending an out-of-state college should check that the plan’s network of preferred providers will work in that area. Otherwise, they may need their own health insurance to ensure the highest level of coverage available.
Some universities will sponsor health insurance plans, which can be more affordable for students in such circumstances.
All employees who have recently become self-employed after leaving a full-time W-2 job can use COBRA to extend a previous employer’s coverage. The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) requires that most businesses provide continued health insurance coverage to all terminated employees. This way, workers can remain covered as they transition to self-employment and search for a new health insurance plan.
All health insurance plans that qualify under the Affordable Care Act (ACA) cover pregnancy and childbirth as one of the 10 essential benefits. Each policy will cover maternity and newborn care services, even if you become pregnant before coverage begins. Once the child is born, your plan may need to have an added family deductible.
Whether you’re currently pregnant or a long-time family planner, you should find a health insurance plan with a family deductible and individual deductibles for each family member. Having a child qualifies you for a special enrollment period, allowing new family planners to switch plans easily. If you’re married without children, you don’t need the additional family deductible.
Veterans and Current Military
The United States Department of Veterans Affairs (VA) provides health care services to eligible veterans. If you qualify for VA health care, the ACA won’t change your benefits. Additionally, veterans with health insurance coverage through an employer can use their VA health care at the same time.
If you’re an active duty service member, your health care is covered by TRICARE. Additional health insurance isn’t necessary for you or your family to comply with the ACA.
What to Consider When Choosing a Health Insurance Plan
As you browse health plans, be sure to consider the following:
1. Choose a Health Plan Marketplace
Many people get health insurance through an employer. In this scenario, your company is your marketplace, and you won’t need to search the government-run health insurance exchange. If your employer pays a portion of the premiums, you can expect this type of coverage to cost less than any plans found through the federal marketplace.
Do you need to know how to get health insurance without a job? Both self-employed professionals and workers without employer-provided health insurance must use your state’s public or federal marketplace. Consider using a private exchange to purchase health insurance.
Whichever way you shop, remember to search for the lowest premiums.
2. Analyze Different Plans
The most common types of health insurance plans include:
- HMO: Health Maintenance Organizations provide lower out-of-pocket costs, but you’ll have less freedom to choose providers. A primary doctor will coordinate your care, typically with referrals required.
- PPO: Preferred Provider Organizations have more provider options and don’t require referrals from a primary doctor. The higher out-of-pocket costs may be worthwhile for these added freedoms.
- EPO: Exclusive Provider Organizations have lower out-of-pocket costs. While you’ll have less freedom to choose providers, your care won’t require referrals.
- POS: A Point of Service plan includes more provider options and a primary doctor who’ll coordinate your care through the use of required referrals.
An insurance agency can help you compare different plans based on your family’s medical needs.
3. Consider the Networks
Often, insurance companies can contract lower rates with in-network providers. When you receive care from an in-network doctor, you can expect lower costs — doctors out of network won’t have agreed-upon rates and will generally cost more out of pocket.
Choose a plan that includes your preferred doctor in the network. If you don’t have a preferred doctor, an extensive network means you’ll have more choices available in your area.
4. Compare Costs
The maximum out-of-pocket amount is listed in your plan information. Rest assured that you won’t surpass the annual limit when paying your deductibles, copayments and coinsurance costs, as premiums aren’t included in the out-of-pocket limit. Generally, lower out-of-pocket costs are the result of higher premiums.
The five factors that go into setting your premium include:
- Your age
- Your location
- Your plan category
- Whether you use tobacco
- Whether your plan has a family deductible
5. Know the Benefits
The ACA requires all health insurance plans available to consumers to cover 10 essential health care services:
- Emergency services
- Laboratory services
- Ambulatory patient services
- Prescription drugs
- Maternity, pregnancy and newborn care
- Pediatric services, including dental and vision
- Mental health care, behavioral health treatment and substance use disorder services
- Services or devices related to rehabilitation or habilitation
- Hospitalization for surgery, overnight stays and other conditions
- Preventive care and services to promote wellness, including chronic disease management
All health insurance plans purchased through the federal marketplace ensure a set of free preventive care benefits, like immunization vaccines and screening tests. Note that women and children have their own sets of services. Check with your insurer to see what preventive care benefits are free for your age group.
Where to Purchase Your Health Insurance Plan
When purchasing a health insurance plan, it’s crucial to know what makes a plan the right fit for you. In general, you’ll want to find an affordable plan that’s specific to your needs, with various ways to purchase health insurance. If you anticipate any changes in the future, like starting a family, you’ll want to keep those variables in mind, as well.
Looking online can be a great way to find a quality health care plan. Browsing an agency’s options will give you a full picture of what they offer so you can make a decision. It can also help to call insurers directly if you prefer communicating with a representative.
Contact Gunn-Mowery for Your Health Insurance Needs
If you’re on the hunt for a new health insurance plan, Gunn-Mowery can help with our quick response times and excellent customer service. Whether you need group health benefits for your employees or only want to browse vision and dental, we’ve got you covered. Contact us today to get started.