It is important for every individuals to keep abreast of health insurance plans available in different states of the United States. As an informed consumer, you need to understand the building blocks of health insurance that will help you avoid misleading lingo and will ultimately help you pick the right plan and also help you end up saving you money. This is where InsureMeNow will come to your rescue and guide you through all the health insurance essentials that will make you competent in making the sound medical and financial decisions without compromising on the coverage.
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Health plans available through the Marketplace have to meet the requirements of qualified health plans. All the qualified health plans should cover essential health benefits, limit the copayments and deductible amounts, and cater to all consumer protection measures required under the Affordable Care Act. The different types of health plans available in the marketplace include:
These plans differ in terms of benefits covered and also based on the level of cost-sharing between the insurers and insured. Bronze plans have the lowest premiums and highest deductibles and other cost-sharing costs, whereas Platinum plans have the highest premium but lowest deductibles. Health plans also differ based on the networks of hospitals and other healthcare providers included in the plan. Enrollees of some of the plans are required to receive all non-emergency care in-network, whereas some of the plans provide some coverage on receiving out-of-network care.
While shopping for health insurance you should take into consideration your health as well as your financial condition. For instance, an individual of 27 years’ age who are in excellent health may opt for a low premium and high deductible plans such as a Bronze or Silver plan. People of older age having a chronic health condition or regular prescription expenses will find a Gold or Platinum plan best and affordable for them. Though these plans have a higher monthly premium but have lower out-of-pocket expenses for doctors’ visits and hospital stays. A disease or illness is quite unpredictable in life so you need to be prepared for the uncertainties that can adversely affect you financially.
There are several options from where you can buy a cheap and affordable plan exactly as per your health conditions and budget. You can buy a health plan either through HealthCare.gov or through your state's marketplace. Besides, some alternative sites allow you to shop, compare, and buy health insurance. The alternative health insurance portals also sell real, legitimate plans available on the marketplace. However, when shopping for alternative sites, you need to be careful as they also offer several plans that may have attractive low premiums, but might not be excluding pre-existing conditions, or offering no real coverage. As an inform shopper, you should be aware that health plans like short-term plans, cancer plans, or accidental plans are not major medical plans and these plans don't offer the protection that is offered with a marketplace plan.
It is mostly observed that while comparing a health plan, you mostly take into account the monthly premium of the plan, as this is the amount you pay every month to be covered. No doubt, premiums are important but it is just one aspect among the different factors that you should consider while finding a cheap and affordable health plan. You also need to be incredibly vigilant while looking at the plans' deductibles as well as copayments. You should try to understand the copayments not just for the doctor's visit but also for the emergency room and for medications. You need to realize that a plan with a low monthly premium but a higher deductible and copayment could end up costing you more in the end than a plan with a higher monthly premium. Besides, premium, deductible, and copays, you may also check whether the plan has coinsurance or not and what will be your total out-of-pocket maximum per year. The easiest way to compare plans is by checking a summary of benefits and coverage that not only lists plans' features but also lays out coverage amount under different potential scenarios.
Apart from the cost, you should pay attention to the list of doctors and hospitals included in the plan's list. You should make sure that your choice of doctor and hospital is included in your plan's network. The healthcare provider directories are available online both on the exchanges and on the insurance companies’ websites, but you should directly call your doctor and confirm whether they accept the plan you are considering to buy or not. Besides, the doctor, you should check whether hospitals near your home and office are in-network with the plans you are considering or not. When choosing a health insurance plan, it is also important for you to think not just about your known anticipated health care needs but also think about a chronic condition and what will your plan coverage in the case of catastrophic illness. Keeping these factors in mind you will be able to choose the best and affordable plan.
Yes, your spouse can obtain health insurance coverage through the exchange, but he cannot receive a subsidy to help pay for the health plans. It is because if you have access to an employer-sponsored health plan that is considered affordable, you cannot obtain a subsidy to pay for an individual plan. The employer-sponsored plans are deemed affordable if the cost of the plan does not exceed 9.83 percent of the household income in 2021. Thus, as long as your employer-sponsored plan costs less than 9.83 percent your spouse would not be eligible for a marketplace subsidy on an individual plan. Your spouse can buy an individual plan from the market but the cost of the plan will depend on age and the type of coverage required.
If you have an individual health plan through on-exchange or off-exchange, you have the option to renew for the coming year without doing anything during the open enrollment period. However, you need to know that this is generally not in your best interest and you should actively compare the available plans during the open enrollment period. You should first carefully analyze and then decide whether to renew your existing coverage or should switch to a different plan. ACA's health insurance exchange was created to foster a sense of competition and choice and to encourage people to first compare health plans and then shop for the plan. This will not be possible if you have selected the auto- renewal option for your health plan.
You can shop for your choice of individual health plan during the open enrollment period or a special enrollment period. The open enrollment period generally starts November 1 every year in the majority of the states and ends on December 15. A special enrollment period is open to people for 60 days after they experience certain life-changing incidence like moving to a new location, getting married, or having a baby.
You can obtain health insurance coverage outside the open enrollment period only in two ways. You can either purchase a health plan during a special enrollment period, if you become eligible for it due to a life-changing experience like losing employer-sponsored coverage, moving to a new place, getting married, or having a baby. Another way of obtaining health insurance out the open enrollment period is through Medicaid or the Children's Health Insurance Program and you can apply any time and can enroll immediately after becoming eligible for these plans.
It is not at all necessary for all marketplace plans to cover the same benefits. Though all marketplace health plans provide coverage for the ten essential health benefits, but health insurance carriers in many states have the flexibility to modify coverage for some specific health care services within each category. However, any modification in the benefits should be approved by the marketplace before making the plans available for purchase. All health plans available in the marketplace need to provide consumers with a Summary of Benefits and Coverage, which is a brief description of the benefits covered under the plan and the way the plan works. The plan's Summary of Benefits and Coverage makes it easier for you to compare different health plans as well as the cost-sharing.