Isurance tips
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Best individual health insurance plans
If you are thinking of buying your own insurance, start your search with websites explaining the basics, such as healthinsuranceinfo.net, sponsored by the Georgetown University Health Policy Institute, and healthcarecoach.com, from the nonprofit National Health Law Program. They will help you understand the concepts and language of health insurance, which are not always easy to understand, and should give you an idea of the questions to ask about any plan. Healthinsurance.org has useful information, but be aware that the site also provides insurance quotes from what it calls “carefully chosen partners who are in the business of selling health insurance.”Then you can noodle around on Web-based brokerages that sell health insurance, including eHealthInsurance.com, HealthPlanOne.com, HealthInsurance.com,. You can get estimates based on limited anonymous information.
Read the fine print of your deductible, which represents the amount you must have before your insurer starts paying. Some policies may have multiple deductibles, including one for each family member. Insurers may also not recognize certain costs in the franchise.
And keep in mind that the fact that something is not in the "excluded benefits" section of your plan does not mean that it is actually covered. For example, insurers generally refuse to cover all treatments they do not consider "medically necessary".
Types of individual health plans
Although they must cover some benefits, health care plans always vary in their structure and the amount of your health care costs they pay.
Health plans are divided into five categories to facilitate comparison. The categories are based on the percentage of health care costs that the plans pay and the portion you pay out of pocket, including deductibles, co-payments, and co-insurance. Percentages are estimates based on the amount of medical care an average person would use in a year. The categories are:
However, some states are extending the time they have to take out health insurance. Currently, these states are:
California – Oct. 15, 2018 to Jan. 15, 2019
Colorado – Nov. 1, 2018 to Jan. 15, 2019
D.C. – Nov. 1, 2018 to Jan. 31, 2019
Massachusetts – Nov. 1, 2018 to Jan. 23, 2019
Minnesota – Nov. 1, 2018 to Jan. 13, 2019
New York – Nov. 1, 2018 to Jan. 31, 2019
Rhode Island – Nov. 1, 2018 to Dec. 31, 2018
The main qualifying life events that will give you a 60-day “special enrollment period” are:
Getting married.
Having a baby, adopting a child or placing a child for adoption or foster care.
Moving.
Becoming a U.S. citizen.
Leaving incarceration.
Losing other health coverage due to job loss, divorce, COBRA expiration or aging off a parent’s plan.
Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP).
For people with a marketplace plan already, having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
Gaining status as a member of an Indian tribe.
You can register at any time of the year at Medicaid or CHIP, federal and state insurance programs for low-income families.
Some health insurance companies sell short-term or temporary health insurance plans outside of the open enrollment period. But these schemes offer only limited benefits. From 2019, anyone can get a short-term plan, up to a year, with the possibility of extending it for two years.
If you do not have health insurance, there is no longer an individual mandate penalty.
Bronze - Pays 60 percent of your health care costs. You pay 40 percent.
Silver - Pays 70 percent of your health care costs. You pay 30 percent.
Gold - Pays 80 percent of your health care costs. You pay 20 percent.
Platinum - Pays 90 percent of your health care costs. You pay 10 percent.
Generally, the less you pay directly for the deductible, the co-pay, and the co-insurance, the more premiums you pay for the hedge. So, in this case, Platinum plans will charge higher premiums than the other three plans, but you will not pay as much if you need health care services. Bronze, meanwhile, has the lowest premiums, but the highest costs.
For example, if you plan to start a family, consider the number of additional fees you will have to pay if you opt for a Bronze plan.
How to buy individual health insurance
Ready to shop? You have lots of choices: Comparison websites, going directly to a health insurance company via its website or call center, contacting a health insurance agent in your area or using your state’s health insurance marketplace (also called exchange).
Not all insurers sell plans through the government-run marketplaces, so you'll find more options by shopping both in and outside the marketplaces.
If you qualify for subsidies, you can get them only by buying through your state’s health insurance marketplace. Healthcare.gov has links to state marketplaces.
You could be eligible for a premium discount in the form a tax break if your income falls below 400 percent of the federal poverty level (FPL). For 2019 health plans, the 400 percent threshold is $48,240 for a single person. Here are more examples:
Household of 2 -- income of less than $65,840
Household of 3 -- income of less than $83,120
Household of 4 -- income of less than $100,400
Household of 5 -- income of less than $117,680
You qualify for a plan with reduced out-of-pocket costs if your household income falls below 250 percent of the federal poverty level -- $30,350 for a single person (the government uses FPL standards from the previous year to determine eligibility).
If you qualify for a tax break, you'll see the premium savings as you shop and compare plans on the marketplace website. Keep in mind that catastrophic plans do not qualify for subsidies.
Comparing health plans
Think about your health care needs and budget, and then compare plans to find the best fit. Here are questions to consider:
How is the plan structured?
When choosing an individual plan, you'll need to pick between four plans. The plans are divided by out-of-pocket and premium costs.
Decide whether you'd rather spend more upfront on premiums or more out-of-pocket costs if you actually need healthcare services. Once you figure that out, you can make a decision whether to go with Bronze, Silver, Gold or Platinum.
Who is in the network?
Check the health plan's network to make sure it has a good selection of hospitals, doctors and specialists. Make sure the providers you want to see are included in the network.
What is covered?
Check to see if the prescription drugs you take are included in the plan's list of covered medications. Compare other benefits. Some plans may go above and beyond coverage mandated by law.
How much do you pay out-of-pocket for care
Review the deductible, copayment and co-insurance amounts. The deductible is the amount you pay each year for covered benefits before the health plan pays anything (except for preventive care). The copayment is the fee you pay for each office visit. Not all health plans have co-payments. Co-insurance is the percentage of covered health care costs you pay after you have met the deductible.
How much do you pay for coverage?
Compare the annual premium between health plans with the same coverage.
What is the bottom line?
Think about the amount of health care you will probably use in the next year and compare the cost of health insurance premiums and unpaid fees for each plan you are considering. If you rarely see a doctor, it is probably best to buy a high deductible (Bronze plan type) health plan with a low premium, compared to a more expensive plan with a reduced deductible.
Making a wise choice in health insurance takes time and effort, but your homework will pay off later when you and your family need care.
With the availability of huge information on the Internet, it has become very easy to compare the plans of different companies. Therefore, give some time before making such an important decision to buy the best health insurance plan.
