With the Open Enrollment for 2017 Health Coverage coming up it is highly important to understand the basics of Individual Health Insurance to choose the best plan for your needs!
In this post you will find valuable information about Individual Health Insurance and its Costs; you will read about the differences between various Health Plans and finally, you will learn how to get Health Care in 2017 at Lower Cost.
What is Individual Health Insurance?
An Individual Health Insurance Plan is selected and paid by you. It covers various medical expenses associated with preventive screenings and immunizations, unexpected health problems and injuries, chronic diseases, etc.
What are the Health Insurance Costs?
You should start the choosing process with comparing your future Monthly Payments - Premiums.
- Premium is a set monthly fee you pay to keep the Health Plan active. Also you get a set of preventive health services at no cost (click here to see the covered services for adults, women and children).
When you determine how much you are willing to pay for Health Care - move over to comparing the Co-Payments.
- Copayment or Copay is a set fee you pay per service: every time you visit a doctor or get prescribed drugs - you are responsible for a certain amount that varies from service to service. Not all Health Plans have Copayments.
Another set amount you pay for Health Services is Deductible.
- Deductible is a certain portion of the medical bill you are required to cover before the Insurance Company starts paying. The deductible amount depends on the type of provided health services. For example, the portion you are responsible for when paying Urgent Care bills is different from the one for Emergency Room, Hospital Stay, Surgery bills, etc.
There is a yearly limit for your Deductible in Health Insurance. And once you reach it - the Coinsurance begins.
- Coinsurance is a simplified way of sharing financial responsibility for medical expenses. It is based on percentage and you are required to cover the smaller portion for all types of medical bills. The ratio depends on the Level of your Health Plan (read more here):
Bronze Plan: 60% to 40%;
Silver Plan: 70% to 30%;
Gold Plan: 80% to 20%;
Platinum Plan: 90% to 10%.
There is good news after all! Once your reach your Annual Deductible and cover your Coinsurance portion - you arrive at Out-of-Pocket Maximum.
- Out-of-Pocket Maximum is the yearly limit for all of your Health Insurance payments. Your Health Care provider keeps records of every deductible and coinsurance portion you pay for various health services. When you arrive at this limit - Insurance Company takes care of all medical bills from now on.
How to select the Health Plan Type that is right for you?
Health Plans come in different "Metal" Levels in accordance with the cost sharing proportions. You have already read about Health Plan Levels earlier in the Coinsurance section.
Apart from this, Health Plans are divided into the Types. These Types are designed for different purposes. Some limit your choice of doctors, pharmacies, hospitals, etc to an exclusive network. Others cover the costs for medical service providers outside of the plan's network. Compare the Plan Types:
- EPO - Exclusive Provider Organization:
With EPO the carrier only covers your medical expenses if you choose doctors, labs or hospitals in the plan's network. in case you prefer the services of a provider outside the plan's network you can be responsible for the entire bill. Some exceptions apply in case of emergency;
- HMO - Health Maintenance Organization:
HMO is very similar to EPO. Your choice of providers is also limited to a specific network. You may also be required to live in a certain Area of Service. The main distinction is that you can see a Specialist only after visiting your designated Primary Care Physician and getting a referral;
- POS - Point of Service:
POS does not limit you to an exclusive network as EPO and HMO do. However you are rewarded by paying less when you choose an approved health service provider. POS requires a referral from your Primary Care Doctor to see a Specialist in the same way HMO does;
- PPO - Preferred Provider Organization:
PPO gives you the freedom to choose providers in and outside the Plan's Network, although as in POS you still pay less choosing the approved providers. Apart from this you are not required to get a referral to see a Specialist.
Download this Health Insurance Fact Sheet not to miss important deadlines applying for 2017 Health Insurance Coverage:
How to get Health Care in 2017 at a Lower Cost?
(If you scrolled all the way through the page to find out how to save on Health Care - we totally understand!)
It is very important to find out if you can get Cost Assistance purchasing Health Insurance for 2017. Cost Assistance includes:
- Advanced Premium Tax Credits: you are eligible if your income is between 100% and 400% of Federal Poverty Level (read more about Poverty Guidelines here). This type of cost assistance lowers the Monthly Premium for your Silver Plan.
- Cost Sharing Reduction Subsidies: you are eligible if your income is within 100% - 250% of Federal Poverty Level (so you get both: Tax Credits and Subsidies). The Subsidies lower your Co-Pays, Deductibles, Co-Insurance and the Out-of-Pocket Limit for services covered by your Silver plan.
Applying for a subsidized plan in order to prove your eligibility you need to provide the following information:
- Household Size;
- Contact Information for each Household Member;
- Date of Birth for each Household Member;
- SSN for each Household Member;
- Immigration Status for each Household Member;
- Income and Tax information for each Household Member;
- Estimation of your Household Income in 2017;
- Current Health Insurance Plan;
- Filled out "Employer Coverage Tool" for each Household Member eligible for a job-based plan.
Thanks for reading! If you have any questions about Individual Health Insurance or would like our assistance applying for 2017 Health Coverage, please contact us at 305 944-0002 or submit a Quote Request and our Agents will start working on your Quote right away!