You may be considering buying health insurance and could use some advice. The Affordable Care Act dramatically changed the rules, eradicating the insurance company’s ability to deny insurance for preexisting conditions. Much of the Act is still in place, with some changes. Yes, you can buy health insurance on your own, but you may find the process surprisingly complicated and confusing. What plan is best for you or your family? What are the pros and cons of each plan? Are you making the best choice?
The last thing you need is the shock of incurring expensive medical bills when you don’t expect it – and this happens to people every day. Health insurance programs vary widely, with the least expensive plan having the highest deductible. The bottom line is that health insurance is unlikely to cover 100 percent of the cost of medical care until your deductible is met, and only for the medical care covered by your plan.
Evaluating Health Insurance Plans
Choosing a health insurance plan that matches your budget involves looking over the following aspects of your options:
- Monthly premium amount
- Copayments for medical services
- Coinsurance costs
- Deductible amount
- Family deductible (for family plans)
- Maximum out-of-pocket
- Your health provider network
Preventative Care is Covered
One big advantage of the Affordable Care Act is that the “marketplace” plans must cover the cost of preventative care. The types of preventative services covered include wellness checkups, vaccinations, and some preventative screenings.
Health Insurance Deductibles – What’s the Story?
The deductible in your plan can turn out to be a big deal financially. While a higher deductible means lower monthly premiums, a serious illness requiring hospitalization could be costly, particularly with a family deductible. In a family plan, each individual person has a deductible, as well as a family deductible. Each family member’s payments for medical care feed into the total family deductible, and once that amount is met, all family members have met the deductible, but it is much more than the individual deductible.
What is the “Maximum Out-of-Pocket?”
The “maximum out-of-pocket” is the most you will have to pay yearly for the services covered by your plan. This amount does not include your monthly premiums, the amount you spent for medical services not covered by your plan, medical services performed out of your network, or the amount your medical provider may charge above what your healthcare plan will pay. The maximum out-of-pocket amount changes year to year, set at $8,550 for an individual and $17,100 for a family in 2021.
Expected Use of Your Healthcare Plan
One of the critical points in choosing a healthcare plan is your expected use of the plan. Your expected plan use, while impossible to completely predict, can be estimated at high, medium, or low. You have the option to select a healthcare plan that reflects your overall health or the health of your family members who may have a health condition that requires more medical care.
Get Help Choosing Health Insurance
If you don’t currently have health insurance or have lost employment-related insurance, our friendly, experienced agents can help you determine what plan will be most workable for you, your family, and your budget.