Under the provision of the Affordable Care Act of 2010 younger adults of age 26 years or older must have their health insurance policy to financially protect themselves for medical emergencies. In the current scenario, many Americans have lost their jobs as well as their health insurance leaving them with no option other than to buy a private health insurance plan. While thinking to purchase a private health insurance plan for themselves and their family people are often concerned about the cost of the health insurance plan. However, the U.S. health insurance marketplace has various health plan options at different prices to cater to the needs of multiple people. The process of purchasing a health insurance plan is not simple, as people have to carefully weigh the different pros and cons of the available health plans before finally purchasing a plan.
Options for Uninsured
Individuals who are not eligible for Medicare or Medicaid and who are not covered under their employer-sponsored plan, have the only option to purchase health insurance plans directly from the private health insurance carriers or through the Health Insurance Marketplace. Besides these, even unemployed individuals, part-time employees, self-employed, business-owner having employees, and individuals who retire before the age of 65 will also only have the option of a private health insurance plan. Any of these individuals who lack health insurance need to enroll in a private individual plan as soon as possible. Though the penalty for being uninsured has been canceled but still people should enroll in a health plan because illness and accidents are quite unpredictable and people need to back themselves for medical emergencies.
Health Insurance Marketplace
The Health Insurance Marketplace was established by the Affordable Care Act to meet the mandate compliance that all Americans should be enrolled in health insurance. People purchasing health insurance plans through the marketplace may be eligible for income-based premium tax credits or cost-sharing reductions. Individuals, families, and small businesses use this platform to purchase health plans. Most of the U.S states have their own marketplaces while residents of the rest of the states use the exchange managed by the federal government. As far as health insurance coverage is concerned, it is always better to have something than nothing.
Factors that Help in Choosing the Best Private Plan
Individuals while shopping for private individual plans in the marketplace will come across different types of health plans like HMO plan, PPO plan, EPO plan, High-Deductible Health Plan, Consumer-Driven Health Plan, Point-of-Service Plan, Short-term plan, and Catastrophic plan. After determining the type of plan, people need to determine the deductible amount that they can afford to pay. A deductible is an amount that people are required to pay for the received healthcare services before their carriers start paying for the covered services. Besides deductibles, individuals are also required to pay the plan’s out-of-pocket maximum and after they pay their deductibles, co-payments, and co-insurance, their health insurance carrier will pay the entire cost of covered benefits.
Cost of Private Health Insurance Plans
Individuals are scared of purchasing health insurance plans because of their increasing price, as enrolling in an employer-sponsored plan is considered affordable. However, studies have proved that even private health insurance plans can end up being more affordable than employer-sponsored plans if they carefully shop for them. Kaiser Family Foundation carried out a study to determine the difference between the average monthly premium of an employer-sponsored plan and a private health insurance plan. The KFF discovered that the average monthly premium for an employer-sponsored plan for individual coverage in 2019 was $603 and was $1,725 for family coverage. Whereas, KFF determined that the average cost of private health plans purchased by individuals for themselves was $440 and the average monthly premium for families in the same year was $1,168. In addition to this, people should also keep in mind that they may even qualify for a cost-sharing reductions subsidy and Advanced Premium Tax Credits if they purchase health coverage through the Health Insurance Marketplace. Individuals who qualify for Cost-Sharing Reduction or Advanced Premium Tax Credits will reduce their monthly premiums as well as their deductible, copayment, and co-insurance.
Different Sources to Buy Private Health Insurance
Individuals while shopping for private individual plans will come across different sources from where they can purchase. Different sources from where private plans can be purchased are:
Medicare.gov – Individuals who have retired or will soon retire can check on the site Medicare.gov for Medicare plans. People are recommended to first check the benefits covered by the standard Medicare plans and then should look for ways to supplement their Medicare plans through Medigap and Medicare Advantage plans.
Healthcare.gov – People can also check for the private individual plans at the health insurance marketplace website to find out about the options for private health insurance coverage available in their area. People can also check their eligibility for any subsidy and they can even apply for it. However, the Health Insurance Marketplace has a specific annual open enrollment period between November 1 and December 15 every year, though some events may extend or reopen the open enrollment period.
Private Health Insurance Carriers – Individuals can visit the websites of major health insurance carriers of their area and can browse through the plans to pick the best plan based on the type of coverage they prefer and the deductible they can afford. The monthly premium of health plans primarily depends upon the region where the individual is living and their age. The health plan price quoted on the website is the lowest price for that plan that is determined assuming that individuals are in excellent health. Pricing and the benefits covered vary significantly based on the health insurance carriers. Thus, at times it becomes difficult to compare the plans and determine which carrier offers the best coverage at affordable rates. However, individuals are advised to choose a plan that aptly meets their coverage requirements within their price range. People should also go through the reviews posted by consumers on those plans that will help them make the best decision.
Factors to Consider while Choosing a Private Health Plan
Private health insurance plans come with a variety of different features. Nevertheless, it is extremely difficult to find a health plan that offers everything people desire. The concept of the best health plan will vary from person to person, as some benefits might be significant for a person while another person might have completely different health care requirements. Thus, find below some of the vital factors that people need to consider while researching for health plans:
Check whether the plan offers prescription drug coverage or not. Whether the plan is offering coverage for a generic version of prescription drugs or offering coverage for branded drugs too. Individuals who already taking any medicines should check that the plan is covering that medicine or not and they should also check the co-payments on generic and branded drugs.
- Check the co-payment for the office visit and if the plan has fixed a maximum number of office visits that it will cover every year.
- Check the so-payment for specialized services like x-rays, lab tests, and surgery along with an emergency room visit.
- Individuals need to determine whether they need a plan that allows them to include vision and dental coverage.
- Individuals who have their preferred doctors should opt for a plan that has their preferred doctor in their list of network doctors.
- Whether pregnancy benefits are required by them or not.
- If you have a preferred doctor, then you should choose a plan that includes your doctor in its insurance company’s provider network.
- Check whether lifetime and annual maximum benefits apply to the plan or not.
- Does the plan provide free or discounted services for preventive care like an annual checkup or not? Most of the ACA plans provide free coverage for most preventive care services.
- Check the hospitals that are included in the network.
- Check the cost for out-of-network services for PPOs plans and individuals can check whether they can afford it or not.
Purchasing a health insurance plan is not as easy as enrolling for an employer’s health plan but people should carefully select the plan after comparing it thoroughly. With multiple health plan options available, people will certainly find a plan that caters to their needs and budget.