How to Choose a Health Insurance Plan Through Healthcare.gov

how to choose health insurance

47 percent of young adults between the ages of 18 and 36 do not have health insurance, usually due to cost, according to a 2013 Harris Poll.

What’s more, medical bills are often the cause of personal bankruptcy.

However, anyone who is a U.S. citizen living in America and not incarcerated can access the Health Insurance Marketplace listed on Healthcare.gov and sign up for coverage.

Most people who use Healthcare.gov do not have employer-offered health insurance because they work for small companies. Or, they’re freelancers or entrepreneurs.

And even if your company does offer insurance, you can get quotes through the marketplace to see if you can get a more affordable plan.

However, navigating the marketplace and website can be overwhelming for first-timers. That’s why we’ve created this guide to help you along the way.

How to choose health insurance

Healthcare.gov offers a wide range of plans, from bare bones versions to premium options that are much more expensive.

Here are a few factors to keep in mind when deciding on a health care plan that’s right for you.

Insurance terms

Before you start comparing plans, it’s important to understand key terms so you can choose a plan that meets your needs.

Your premium is the monthly bill you pay for your health insurance plan. Whether you go to the doctor or not, or receive any prescriptions, you owe the premium every month.

Your deductible is the amount you have to pay before your insurance begins to pay anything. Plans with a higher premium have lower deductibles.

A high deductible will give you a lower monthly bill, but you will end up paying more of your own health expenses in the long-run.

Copayments and coinsurance are the amounts you pay for medical care after you meet the deductible. For example, you may owe $20 at the doctor’s office for a follow-up visit.

You need to think about what is most important to you: a low deductible or a low premium. That will help you decide which plan is the best for you financially.

Four insurance categories

Healthcare.gov offers four overarching categories: bronze, silver, gold, and platinum. The different groups are determined by their overall costs and are not related to the quality of care.

Bronze plans

Under a bronze plan, the insurance company covers 60 percent of your medical expenses and you cover 40 percent.

These plans tend to have the lowest premiums. However, when you do need medical care, you pay more out of pocket.

Ultimately, they are a good choice for people who are healthy and who only need protection for medical emergencies.

Silver plans

With a silver plan, you pay for 30 percent of your medical bills and the insurance company covers 70 percent.

Silver plans cover more of your routine care and the costs are moderate compared to higher-tier plans.

Gold plans

Insurance companies cover 80 percent of your medical bills under a gold plan, leaving you responsible for 20 percent.

They have a high monthly premium, but a lower deductible. If you have a lot of medical needs, a gold plan may be a good option.

Platinum plans

Under a platinum plan, you cover just 10 percent of your medical expenses. The insurance plan covers the rest.

Your deductible is very low, so your insurance kicks in quickly to cover the costs of your care.

These plans are wise choices for people who have a lot of health care needs and who want the majority of their costs covered.

Think about how much care you usually need in a year and how often you go to the doctor before selecting a tier.

PPOs, HMOs, POS, and EPO

When considering how to choose a health insurance plan, it’s important to understand the different acronyms for plans and network types.

Next to your options in every category, you’ll see letters like PPO, HMO, POS, and EPO. Each acronym refers to plans that determine what doctors you can go to.

Preferred Provider Organization (PPO)

Under a PPO, you pay less if you use the insurance company’s network of doctors and hospitals. But you can use healthcare providers outside of the network if you choose, without a referral, for an extra cost.

Essentially, PPOs give you more flexibility in what doctors you see.

Health Maintenance Organization (HMO)

HMOs limit you to providers within the network unless it’s an emergency. Out of network care is not covered, and you need a referral to see a specialist.

Point of Service (POS)

With a POS, you pay less if you use in-network doctors. But you do need a referral to see specialists.

Exclusive Provider Organization (EPO)

Services are only covered under an EPO plan if you use doctors and health care providers within the network.

Remember, when you are choosing between plans, you will see that each plan offers a provider directory. So if you have a doctor you love, check and see if they are within the network to ensure your insurance will cover your visits with her.

Formularies

One other major factor in deciding how to pick health insurance is the insurance formulary. If you have medical conditions that require you to take medication, the formulary is a big deal.

The formulary is a list of drugs that the insurance provider covers under a particular plan. Some medicines are covered under certain plans but not others. Or, they may be more expensive under some plans.

Ultimately, each plan listed will have a link to the formulary. So you can look up your specific medications to see if a specific insurance plan covers them.

Dental and Vision

Healthcare.gov offers both vision and dental plans as optional add-ons for adults.

If you opt out of signing up for either add-on, the government will not penalize you. You are only required to have general health insurance.

Plans range from basic options that include routine cleanings and X-rays to more expensive versions that cover more intensive procedures.

Adding on dental and vision can add to your monthly premiums. So be sure to consider your unique needs and how often you visit the dentist or ophthalmologist before signing up.

What you need to enroll

You can enroll online, but you will need to have certain information on hand.

To complete your health insurance application on Healthcare.gov, make sure you have the following:

  • Information about your household size
  • Home and mailing address for each person applying
  • Information about each person, including birthdates
  • Social security numbers
  • Information on how you file your taxes, such as your tax returns from last year
  • Employer and income information
  • An estimate for your 2017 income
  • Policy numbers for your current insurance policies
  • Plan ID from 2016 (if you had insurance)

What changes are there for 2017?

When thinking about how to choose a health insurance plan, keep in mind the following changes for 2017.

The open enrollment period starts on November 1 and ends on January 31, 2017.  So if you want your coverage to start on January 1 of the new year, the deadline to enroll is December 15. If you apply after that date, your insurance will not kick in until February.

If you do not enroll during the open enrollment period, you will not be able to get health insurance. And, you will owe a penalty for each month you do not have coverage, which is pretty steep.

The only exception to paying the penalty fee is if you had a major life event, like you lost your job, got married, or had a baby. Then you can enroll in a plan through a special enrollment period.

The penalty fee is either 2.5 percent of your income, or one fine per person, whichever is higher. The per person fine is $695 and $347.50 for every child under 18 who does not have insurance.

Keep in mind that you can get a basic bronze plan through Healthcare.gov for less than the penalty. Essentially, getting insurance is more cost-effective than paying the fee.

More than 85 percent of people who enrolled in a plan through Healthcare.gov qualified for a subsidy from the government last year, according to a report last year from the U.S. Department of Health and Human Services.

Subsidies ultimately make insurance more affordable for plan holders who qualify for them.

Enrolling in a plan

Figuring out how to choose health insurance can be frustrating and overwhelming. However, health insurance provides an essential safeguard for your physical health and financial well-being.

See for yourself how you can apply for a plan and pay for your premiums entirely online.

Or, if you need more help choosing the best plan for you, you can also get free help over the phone or in person from trained navigators and assisters.

Just visit Healthcare.gov’s local help section and type in your zip code to find free assistance services in your area.

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