HEALTH COVERAGE

Your lifestyle is unique. So are your health insurance needs. You may be self-employed, not employed or just searching for a new health insurance plan. You want to prevent health problems. You want treatment coverage when problems occur. And, you want to keep health care expenses as low as possible. Reading this article can help guide you towards the individual health insurance plan that best meets your coverage needs and budget. If for some reason you can’t get coverage through your employer any more, you’ll still need a health plan. For many people, that means buying individual health insurance.

Unlike traditional employer-sponsored insurance, now you will –

1. Shop for and choose a plan that covers you and your family

2. Purchase your plan

3. Make all monthly premium payments

4. Get to know and manage all of your health coverage and benefits

Understanding Health Insurance Terms

We know health insurance has its own language with different terms, like deductibles, coinsurance and co-payments. Once you get a good grasp on some of these basic terms, you’ll see how simple health insurance can be. Let’s start by defining these terms –

1. Deductible: This is a set amount you have to pay toward your treatment bills every year before your insurance company starts paying. It varies by plan and some plans have no deductible.

2. Premium: This is the amount you pay your health insurance company to keep your coverage active. Most people pay their premium monthly.

3. Coinsurance: This is the percentage of your treatment bill you share with your insurance company after you’ve paid your deductible. Unless you have a policy with 100 percent coverage for everything, you have to pay a coinsurance amount. For example, if you have a 100 dollars hospital bill and your plan covers 80 percent of it, your coinsurance amount due to the hospital is 20 percent, or 20 dollars.

Different Types Of Plans

For starters, here’s a little refresher of the most common of the major treatment plans each of which cover a wide array of healthcare needs and include physician visits, and hospital care that are offered today –

1. Indemnity plans – These tend to be the most flexible of the major treatment plans, you choose which physician or hospitals you visit, and no referrals are required–but they also typically require some sort of annual deductible to be paid before your insurance company will start paying on your claims.

2. Preferred Provider Organization: PPO plans – With a PPO plan, you can visit any “in-network” physician or healthcare provider you wish without a referral. You can receive care outside of the network, too, but if you do so you’ll probably pay a higher deductible.

3. Health Maintenance Organization: HMO plans – If you become part of an HMO, you’ll likely have to choose a primary care provider who will, from then on, manage most of your healthcare needs, which means you’ll need a referral to see a specialist. Also, HMOs usually don’t cover or only barely cover out-of-network care and services.

4. Point of Service: POS plans- In a nutshell, these plans combine elements of the HMO and PPO models. Like an HMO, you’re probably going to have to select a PCP, but like a PPO, you can go to out-of-network care providers, too and if your PCP refers you in such cases, the health plan may cover the cost.

A common way to compare Health insurance plans is by the total cost the total annual premiums plus the maximum out of pocket that you’d incur with each plan. If you qualify for a premium subsidy, be sure to use the after-subsidy premium for each plan when you’re calculating how much the coverage will cost. You can determine your after-subsidy premium by using your exchange’s plan browsing tool. It only takes a minute or two and doesn’t require any identifying data. You can also use a subsidy calculator on insurance websites to get a close estimate of how much you’d save on ACA-compliant coverage.

If you are eligible for a premium subsidy, it’s also wise to consider additional cost savings through cost-sharing reductions or CSR that are built into Silver plans. If your household income does not exceed 250 percent of federal poverty guidelines, you’re eligible for cost-sharing subsidies in addition to premium subsidies. CSR benefits are particularly strong if your household income doesn’t exceed 200 percent of the poverty level. If you’re in that range, a Silver plan will likely provide you with the best value.

Plan availability and coverage options vary considerably from one area to another. Some parts of the country have only a single insurer that sells individual health insurance, while other areas have several different insurers and dozens or even hundreds of healthcare plans from which to choose. To get a clearer picture of your potential plan costs, it’s worth seeking personal assistance from a navigator or broker to talk with a licensed, exchange-certified broker who can enroll you in an excellent plan.