How To Pick The Right Health Insurance Plan – How to find the best health insurance plan for you and your family: Shots – Health News The open enrollment period to buy health insurance on HealthCare.gov starts now and runs through January 15, 2022. Look for more options and expanded subsidies this year — and more help with registration.
If you’re shopping for health insurance outside of a job-based plan, you’re in luck this fall. After years of cutting and — some say sabotaging — the Affordable Care Act during the Trump administration, the Biden administration is taking steps to help people find good health plans on HealthCare.gov right now — the open enrollment period starts this week. You’ll have more time to sign up, more free help choosing a plan, and you’ll be more likely to qualify for subsidies to lower the cost of a health plan you buy through the ACA Marketplace.
How To Pick The Right Health Insurance Plan
However, choosing health insurance can be a difficult task, even if you choose a plan through your employer. There are many confusing terms and the process forces you to think carefully about your health and finances. You also need to do everything in time, often with just a few weeks to explore your options and make decisions.
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Whether you’re aging out of your parent’s plan and choosing it for the first time, or you’re in a plan that no longer works for you and are ready to switch things up, or you’re not sure and want to see if there are any options that work, there is good news. Asking a few simple questions can help you find the right plan out of all the ones on the market.
Here are some tips on where to look and how to get reliable advice and help if you need it.
It’s not always clear where to look for health insurance. “In this country, it’s a really crazy combination of possibilities,” said Sabrina Corlett, associate director of the Center for Health Insurance Reform at Georgetown University.
If you are 65 or older, you are eligible for Medicare. It’s a federal program—the government pays for most of your health care. You may also be eligible if you have certain disabilities. For those already enrolled in Medicare or a Medicare Advantage plan, the open enrollment period to change to supplemental health and prescription drug plans for 2022 continues through December 7 of this year.
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For those under 65, says Corlett, “the vast majority of us get coverage through our employer. The employer will typically cover between 70% and 90% of your premium costs, which is pretty good.” Check with your supervisor or your company’s human resources department to find out what, if any, plans are available to you under time of your work.
Then there’s Medicaid, the health insurance program for low-income people that covers about 80 million people — nearly one in four Americans. It’s funded by both the federal and state governments, but it’s administered by each state, so whether you’re eligible depends on where you live.
For almost everyone else, the place to go is Healthcare.gov, where you can buy insurance in the marketplaces created by the Affordable Care Act, also known as Obamacare.
This is where you look for health insurance if you don’t fit any of the categories we mentioned before, says Corlett—if, for example, “your employer doesn’t offer coverage; you are not eligible for Medicare because you are not old enough, no; and you are not poor enough for Medicaid. You can go to the marketplaces, apply for financial assistance based on your income and choose a plan there.
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If you are generally healthy and choose one or two plan options at work, the choice can be quite simple. You can simply ask your colleagues what they like, apply through the online benefits portal and leave it at that.
However, when shopping the Affordable Care Act marketplaces, the number of choices can be overwhelming at first. In Austin, Texas, “we had 76 plans to review with clients,” says Aaron DeLaO, director of health initiatives at the Community Foundation.
Even with dozens of options, you can narrow things down to a few basic questions, DeLaO says. First, ask yourself, “Do you [just] want insurance for that catastrophic event that could happen, or do you know you now have a health problem that will require ongoing care?”
If you’re relatively healthy, any of the different plans can work. But if you or your spouse or dependent family member have certain ongoing health needs (such as an underlying medical condition, or plan to undergo infertility treatment in 2022, or need to see a certain medical professional), this information can be very helpful , to help you narrow down the field to the best health insurance choice. “If there’s a plan that doesn’t have your provider or your drug in the network, it can be eliminated,” he says.
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Sometimes you can enter your drugs or doctor names while searching for plans online to filter out plans that don’t cover them. You can also simply call the insurance company and ask: Is my provider in network for this plan I’m considering? Is my drug on the plan’s formulary (the list of drugs the insurance plan will cover)?
There are also two main different types of plans to consider. “You may have a choice between what’s called an HMO or a PPO,” says Corlett. A healthcare organization usually has a strict network of providers – if you see an out-of-network provider, all costs are on you. A preferred provider organization “will give you a much wider choice of providers—it might be a little more expensive than an out-of-network provider, but they’ll still cover some of those costs,” she explains.
How much can you afford to pay for health insurance each month? To compare the actual total cost of health plans and find out which one might work best within your budget, you need to familiarize yourself with some important insurance terms—words like premium, cost-sharing, deductibles, and deductibles.
Insurance companies use these different types of fees—premium versus deductible, for example—as a way to keep their own costs under control. The basic plan they sell can lower the monthly premium for a certain plan so it looks cheap. But that same plan might have a high deductible of, say, $6,000 — meaning you have to spend $6,000 out of pocket on health care each year before your insurance starts paying its share of the costs. . If you choose this plan, you’re betting you won’t have to use many health care services, so you’ll only have to worry about your — hopefully affordable — premiums and the cost of a few appointments.
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If you have a chronic illness or are simply more risk-averse, you can opt for a plan with increased premiums instead. You’ll pay a little more each month than you would for another plan, but your costs will be more predictable — you’ll likely have lower deductibles and lower coinsurance rates. That way, you can go to a lot of appointments and get a lot of prescriptions and still have a manageable monthly cost.
What plans are available and affordable to you will vary depending on where you live, your income and who is in your household, and your insurance policy. With the pandemic, Congress approved new temporary funding to cover more out-of-pocket costs for people—depending on your income, you may qualify for plans with premiums of $10 or less per month on HealthCare.gov or on your state’s ACA exchange.
Still feeling overwhelmed by all the ACA choices? You are lucky. Free, unbiased expert advice is available to help you choose and enroll in a plan. Just enter your ZIP code at Healthcare.gov/localhelp and search for a “helper” — a person also called a health navigator on some government websites.
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Aaron DeLaO is one such navigator, and he notes that he and his fellow guides don’t work for a commission — they’re paid by the government. “We have no contracts with insurance agencies,” he says. “We do it completely autonomously, impartially. It’s about what’s best for the consumer.”
In 2021, the Biden administration quadrupled the number of navigators ahead of open enrollment. (The Trump administration has severely cut funding for the program.)
Insurance brokers can also be helpful, says Corlett. “Brokers get commissions, but in my experience, good brokers want repeat customers, and that means happy customers,” she says. To find a good broker, she advises, “go through either Healthcare.gov or your local state insurance department to find someone who is licensed and has a good reputation.”
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