Selecting the best health insurance plan can be overwhelming. If you don’t get health insurance through your workplace, you’ll likely use the federal Affordable Care Act Marketplace or your state’s Marketplace to choose the best plan for your lifestyle, which can lead to a lot of unanswered questions .
Here’s what you need to know to better compile health insurance quotes and select the right plan for your needs.
Reading: How to get health insurance quotes
what is health insurance?
Health insurance is a type of insurance that covers all or part of the medical expenses associated with an illness or injury. it’s meant to protect you from expensive medical bills that you might not otherwise be able to cover on your own.
“Health insurance is sold by a company for a monthly fee or premium,” says Adam Block, Ph.D., a health economist and assistant professor of public health in the division of health policy and administration at the new york college of medicine. “in return, the company pays for health care expenses that are deemed ‘medically necessary’.”
Health insurance also makes preventive care, like routine doctor visits and health screenings, more affordable and accessible, which can help minimize illness and injury in the first place.
how much does health insurance cost?
The average monthly cost of health insurance in the market here is $365 for individual coverage for a 21-year-old, $386 for a 27-year-old, $412 for a 30-year-old, $469 for a 40-year-old -years, $655 for 50 years and $994 for 60 years.
The actual cost varies for a number of reasons, says Molly Moore, vice president of market strategy at zero.health, a company that uses technology, data and plan design to help employers with health care. the type of insurance coverage you want, where you live, and your age are all part of determining the price.
Prices are different for people who pay for their own health insurance plan compared to those who get their group health insurance through their employer. “If your employer offers health insurance, he’ll likely pay a percentage of your health insurance premium, which will lower your overall cost,” says Moore.
where to look for health insurance quotes
There are three basic ways to shop for health insurance.
Your Employer: Any employer with more than 50 employees is required to offer health insurance coverage to full-time employees. large employers that don’t offer health insurance face a tax penalty. If you’re currently working or looking for work, make it a priority to ask about health insurance benefits. Your employer will usually work with a health insurance company to offer some plan options, so discuss these options with management or human resources to make sure you understand how they are different.
Marketplace/Exchange: If your employer doesn’t offer health insurance or you’re unemployed, you can find a health insurance quote through the Affordable Care Act (ACA) Exchanges at Health Care. government the aca is a comprehensive reform law that works to increase health insurance coverage for anyone who doesn’t have insurance.
A Broker: A health insurance broker is another option for those who are unemployed, self-employed, or work in a place where health insurance is not offered. A broker is a licensed person who can help you enroll in a plan by making recommendations based on your personal circumstances at no additional cost. They can also help you apply for help paying for health insurance. Working with a broker is also great for anyone unsure how to navigate state exchanges.
Health insurance exchanges are platforms that provide users with the opportunity to compare various health insurance plans to determine which best suits their needs. Brokers generally receive a commission from the health insurance company you choose to purchase coverage from.
questions to ask when requesting a health insurance quote
Whether you’re exploring insurance options with an employer, talking to a broker, or researching plans on the Marketplace here, there are some important questions to ask yourself when trying to find the right quote for you.
“You need to take into account the total cost of your health plan (premium, deductible, copays) and get an idea of what you predict you will need when it comes to health care in the next year,” says Moor Ella suggests thinking about things like whether you plan to grow your family in the near future (if so, ask about things like prenatal coverage and family plan options) or whether you might need a joint replacement (if so, ask about surgery and hospital coverage). ).
Also, consider any pre-existing conditions or illnesses that may affect health insurance costs. think about how often you plan to see your doctor in the next few months and what kind of medicine you need.
See also: Who Can’t Pay for Health Care? – PMC
These are some questions you may need to answer when requesting a health insurance quote:
- what types of plans are available?
- What metal level does it drop below?
- what add-on plans are available?
- what is a hdhp?
- what is an hsa?
- what is a deductible?
- what are the out-of-pocket costs?
- How are medications covered?
- Is coverage offered abroad?
- Is maternity coverage offered?
- Is there coverage outside the network?
- Are references required?
- Bronze: You pay much lower monthly premiums, but plan members pay higher out-of-pocket costs when they need care. bronze plans pay 60% of your health care costs and you pay 40%. if a medical situation arises, you have higher costs.
- Silver: Silver metal plans include moderate monthly premiums and moderate costs with covered care. “For those who qualify for cost-sharing reductions, choosing a silver plan can result in additional savings on out-of-pocket costs (deductibles, coinsurance, copays, etc.),” Moore says. a silver health plan pays 70% of the costs and you pay 30%.
- Gold: This tier typically covers about 80% of health care costs and has higher monthly premiums but lower out-of-pocket costs. “Gold plans can be good options if you plan to use a lot of medical services, need to see a lot of specialists, or have been diagnosed with a serious or chronic health condition,” says Moore.
- Platinum: Platinum plans generally cover about 90% of health care costs and have the highest monthly premiums and lowest out-of-pocket costs. If you use a lot of care and can afford a higher monthly payment, this level is a good option. but you may have trouble finding a platinum plan since health insurance companies don’t offer many of those plans on the market here.
- Dental: Most commercial health insurance plans do not cover dental. however, some employers offer it, and you can also purchase dental insurance through a private insurance company on your own. coverage generally includes at least a portion of visits and procedures.
- Vision: Most commercial health insurance companies also do not cover vision. But like dental insurance, vision insurance can be offered through an employer or a private insurance company. coverage varies and may include visits, procedures, and prescriptions for glasses and contact lenses.
- Pediatric Services: This type of supplemental plan generally provides pediatric dental and vision coverage.
- Critical Illness: This plan covers expenses related to serious qualifying illnesses, such as cancer. These plans often offer a lump-sum cash benefit that can be used for deductibles, out-of-network specialists, experimental treatments, and child care.
- Accident: There are two types of accident policies: accidental death and dismemberment (ad&d) insurance and supplemental accident insurance, which are usually sold together. benefits vary by state and insurance provider. ad&d typically pays a lump-sum cash benefit to the beneficiary of someone who was killed or seriously injured in an accident, while supplemental accident insurance typically pays for medical costs resulting from an accident or injury.
- Hospital Indemnity: Hospital indemnity insurance typically provides a cash benefit to someone who is in a hospital for an extended period of time due to a serious illness or injury.
- Tier 1: Affordable generic drugs on the formulary
- tier 2: more expensive brand and generic drugs on the formulary
- tier 3: non-formulary drugs, generic or brand name
- tier 4: specialty drugs
what types of plans are available?
The type of plan you choose determines the flexibility of your health insurance. Some plans allow you to see almost any doctor, while others restrict your choices to in-network providers only. plans also vary in cost. There are four basic types of health plan benefit designs: hmo, ppo, pos, and epo.
What metal level does it drop below?
Health plans on the ACA exchange are generally organized into four levels, called “metals.” tiers show how you and the plan share costs and are classified as bronze, silver, gold, and platinum.
Looking at the levels, Moore says it’s more about budget than quality of care. “Remember it’s about your comfort level with risk and your family budget,” she says. “Do you want to pay more per month to have the peace of mind that, if something happens, you will have to pay less money at the time of care? or do you want to pay less each month and set aside some money in your health savings account (hsa) to address your needs, should they arise?”
here is a brief look at metal levels.
what add-on plans are available?
Supplementary plans refer to additional insurance you can buy to help pay for services and out-of-pocket expenses that your primary health insurance plan doesn’t cover.
There are several types of supplemental plans. determining if you need one depends on your budget and the level of care you need. Supplemental insurance plans and coverage differ depending on the company selling the plan. Some examples of add-on plans include:
what is a hdhp?
an hdhp is a high deductible health plan that generally has lower monthly premiums but higher out-of-pocket costs.
having a hdhp means you are eligible for a health savings account (hsa), which allows you to pay for certain medical expenses with pre-tax money. For 2022, the Internal Revenue Service (IRS) has defined an HDHP as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. Total annual out-of-pocket expenses (such as deductibles and copays) cannot exceed $7,050 for an individual or $14,100 for a family, not including out-of-network services.
By 2023, the IRS will define an HDHP plan with a deductible of at least $1,500 for individual coverage and $3,000 for family coverage. the out-of-pocket maximum will be $7,500 for an individual and $15,000 for a family.
what is an hsa?
A health savings account (HSA) is intended to help an individual manage health care costs. hsas are tax-free accounts you use to pay for eligible health care costs. you put the money in tax-free, you take it out tax-free, and you get the compound growth tax rate.
You must have an hdhp to have an hsa. This pre-tax account can cover everything from prescription copays to humidifiers to contact lens care.
what is a deductible?
A health insurance deductible is the amount you must pay annually for health care services before your health insurance plan starts making money.
Once you meet your plan’s deductible, you generally meet your health plan’s coinsurance portion. With coinsurance, you and the health plan each pay a percentage for health care services. you continue to pay coinsurance until you reach your plan’s out-of-pocket maximum.
what are the out-of-pocket costs?
Out-of-pocket costs refer to the patient’s out-of-pocket costs associated with medical care. Your plan’s deductible and coinsurance (and copays for some plans) count toward your out-of-pocket costs. health insurance premiums are not included in your out-of-pocket costs.
how are medications covered?
Health insurance helps pay for the cost of certain prescription drugs. The drugs that cost the least out of pocket are the drugs on a plan’s formulary. A formulary is a list of generic and brand name prescription drugs that are covered by a health plan.
block notes that there are generally four payment tiers for drugs:
To find out what your plan covers, look for the formulary, which may be on the insurer’s website, in your summary of benefits and notice of coverage from the insurance company, or in any coverage materials your provider sends you. plan. You can also contact the insurer directly for this information.
Is coverage offered abroad?
Overseas coverage may be considered supplemental insurance and is generally not covered by primary health insurance plans. You can contact your insurance provider to see if they offer coverage abroad.
Is maternity coverage offered?
Maternity coverage is considered an essential health benefit and is always offered in a standard health insurance plan, even if your pregnancy begins before your coverage begins.
Is there coverage outside the network?
It is important to consider the possibilities of out-of-network coverage. Health insurance companies contract with doctors and medical establishments. these providers are considered your plan’s network.
Some plans like ppos allow you to get care outside of their network at a higher price, while hmos and epos usually don’t.
Check the health plan’s provider network to make sure there are providers in your area that accept insurance. this is especially crucial if it’s a plan that doesn’t pay for out-of-network care.
Depending on your health insurance plan, you may need to get a referral from a primary care provider to see a specialist. hmos generally require referrals, but ppos and epos generally do not require referrals to see specialists.
When your plan doesn’t require a referral, you often have more flexibility in scheduling appointments with specialists and worry less about the costs involved. but that flexibility often comes with higher premiums.
what to look for in a health insurance plan
When comparing health insurance plans on the ACA Marketplace, you want to compare the plans’ premiums, out-of-pocket costs like deductibles and coinsurance, and benefit designs and provider network.
Premiums are a type of health insurance cost. you pay a premium to have health insurance coverage. in the market, the bronze and silver plans tend to have the lowest premiums, while the gold and platinum plans have the highest premiums.
You shouldn’t choose a health care plan based solely on premiums. Out-of-pocket expenses also play a vital role in overall health expenses. Out-of-pocket costs, including deductibles and coinsurance, are what you pay when you need health care services. the gold and platinum plans have the lowest out-of-pocket costs, so you’ll pay less when you need care with those plans versus the bronze or silver plans.
The metal level of a market only helps you estimate health care costs. however, it does not take into account the benefit design of the plan. benefit design includes whether the plan allows out-of-network care, requires members to choose a primary care provider, and mandates whether members need referrals to see specialists. A plan’s benefit design influences not only how much flexibility you have, but also how much you pay for out-of-network services.
Regardless of which health plan you’re comparing, you should delve into the plan’s network of providers. check to make sure your providers are in the plan. If there aren’t many providers or facilities that accept the health plan in your area, you may pay more if you need care outside the network. Some plans allow you to get care outside the network, but that costs more than in-network care.