Now is the time when most of America is making a decision (well perhaps a couple of decisions). Outside of the election you’re probably deciding whether to keep your existing insurance plan or change to one of the other competing plans. This can be quite an overwhelming decision, not just because prices are rising but it can be difficult and confusing to understand your options. Here are some tips to help you narrow down your options in several different situations:
If You Purchase Insurance at Work
Most Americans aged 65 and younger purchases their insurance through work. The plans that are offered through employers can vary significantly. The most important thing that you need to know is what insurance company or companies your employer offers plans through. Ask for a Summary of Benefits for each option. It will answer some very important questions, including:
- The plan’s benefits. This will list exactly what is covered and list the limitations, too.
- Cost-sharing responsibilities. This will include your deductible, co-payments, and co-insurance.
- Who are the doctors in your network? Most health plans have a list of doctors, hospitals, labs, etc. in their network that offer them the best price. You will choose your service providers from this list, so you want to check the list to be sure that you can find providers that you can trust, especially if you have an established provider that you do not want to change.
- How much will your prescription drugs cover? The drug price list, known as the formulary, may be on the website, but you want to double-check before changing plans, because this list can change quickly. Make sure it includes the drugs you take on a regular basis.
- When can you join the employee plan? Switching can generally only be done during the annual enrollment period, but other special enrollment circumstances could apply as well. This could include situations such as if your spouse loses their job, you qualify for coverage through your spouse’s group plan, you have a child, etc.
If You Buy Insurance on Your Own
Buying an individual health insurance plan can be overwhelming for many people as they do not seek out expert advice to help them choose a plan. You may have heard about the health insurance rate increases impacting Obamacare plans this year and be worried that you can’t afford a plan, however what many people don’t know is that almost 90% of enrollees are eligible for subsidies to help make plans affordable. If you’re one of the people eligible for a subsidy you should consider plans sold through the Health Insurance Marketplace.
Health Insurance Exchange/Marketplace
The insurance that you purchase from the Health Insurance Marketplace qualifies for income-based subsidies that include premium tax credits and cost-sharing reductions. In order to keep plans affordable, plans sold through the Marketplace may offer smaller networks, meaning you’ll have less choice of healthcare providers. Finding the balance of network size and cost is a key step in finding a plan that meets your needs.
A private health insurance plan sold outside of the exchange may cost you more, as it does not qualify for those income-based subsidies. The increased plan cost may provide larger care networks and lower out-of-pocket costs. If you prioritize provider choice over having the lowest premium it’s worth considering an off-exchange plan.
Compare On-Exchange Plans and Off-Exchange Plans
It is important that you look at plans both in the marketplace and through private health insurance. Here are some tips if you are buying insurance on your own:
- Look at all the options. This includes group plans offered through employers, plans through the Marketplace, and plans that you can purchase on your own. The prices will vary substantially, but you may find a plan that will work perfectly for your budget and your particular medical needs.
- Understand what you need. A good plan takes care of current needs, but also protects against future expenses in case of accidents or major illness. You want a comprehensive plan that covers treatments and doctors for such things as chemotherapy, rehab, mental-health care, and more.
If You Are 25 or Younger
A big provision in the healthcare-reform law was that you no longer have to worry about being kicked off of your parent’s health insurance plan after high school. Children remain covered by their parent’s coverage until their 26th birthday, even if they are not in school or living with them. Here are some things to consider if you are younger than 26.
- Am I eligible to stay on my parent’s plan? Yes. Even if you move away from home, become self-supporting enough that your parents cannot claim you as a dependent, or even get married, you can stay on your parent’s insurance.
- My parents are retired. Will that make a difference? If your parents are on Medicare, you are out of luck, as the plan does not cover dependents.
- Can I rejoin my parent’s plan after I leave it? Yes. If you are younger than 26, you can do it as many times as you need to.
- What happens when I am too old for my parent’s plan, but do not yet have a job with health benefits? It is time for you to shop around for an individual policy. Your age will make the premiums relatively affordable in the Marketplace.
- I am the parent. What do I need to know? Your employer cannot charge a different premium for your adult children than it does for your younger ones. Check the provider options for your child if they will be living away from away from home, as you may have to look for a different plan if there are not any providers near your child.
- I’m away at college, am I covered? The level of coverage may depend on your parent’s plan. Check with their policy to see what your care options are like around your school. If coverage is limited you should consider enrolling in your own plan.
If You Have a Pre-Existing Condition
If you have a pre-existing condition and buy your insurance through work, you do not have to worry about being denied coverage. That has been the law for a long time. With the Affordable Care Act, it is now a law that insurance companies cannot deny coverage or charge more for people with existing conditions. In fact, insurance companies can no longer deny you for any reason other than fraud, and cannot put a lifetime or annual dollar limits on Essential Health Benefits. When looking for coverage you should compare how much each plan charges for your prescription medication needs and any specialist care you receive. The plan with the lowest premium may not be your best option. Look for a plan that offers the best prices for your care needs and an affordable premium.
No matter where you are in life, it is essential that you take the time to compare and contrast the different options that are available to you. Compare employer-sponsored plans, Marketplace plans, and private plans to find the best plan for you, your budget, and your needs.
HealthMatchup can help you compare both off and on-exchange plans. Compare plans online by clicking here or speak to an expert by calling (866) 684-7314.