Monday, January 27, 2014
Tuesday, January 7, 2014
Each insurance brand may offer one or more of these four common types of plans:
Here are 6 things to consider before choosing a health insurance plan:
- The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs.
- Plans in all categories offer the same set of 10 essential health benefits and the categories do not reflect the quality of care the plans provide.
- When choosing your health insurance plan, keep this general rule of thumb in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.
- Think about the health care needs of your household when considering which Marketplace insurance plan to buy. Are you likely to need a lot of care? Or a little?
- If you can’t afford health insurance, you may be able to get lower costs on your monthly premium. You may qualify for lower out-of-pocket costs for copayments, coinsurance, and deductibles.
- Other options like Medicaid or the Children’s Health Insurance Program (CHIP) may be available to you. The Marketplace also offers catastrophic plans to people under 30 years old and to some people with very low incomes.
An HMO delivers health services through a network. With an HMO, you may have:
- The least freedom to choose your health care providers
- Predictable out-of-pocket costs
- The least amount of paperwork compared to other plans.
- More preventive care in your benefits package
- A primary care physician to manage your care and refer you to specialists when you need one so the care is covered by the health plan
- No deductible
- Copays for each type of care
With a PPO, you may have:
- A moderate amount of freedom to choose your health care providers — more than an HMO
- Higher out-of-pocket costs than an HMO
- More paperwork than other plans if you see out-of-network providers
- The ability to manage your own health care
- Premium — Your monthly payments are based on the negotiated rates PPOs have with their network providers.
- Deductible — Some PPOs may have a deductible. You may have to pay a higher deductible if you see an out-of-network doctor.
- Copay or coinsurance — A copay is a flat fee, such as $15, you pay when you get care. Coinsurance is when you pay a percent of the charges for care, such as 30%.
- Other costs — If your doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.
- Paperwork involved. There’s little to no paperwork with a PPO if you see an in-network doctor. If you use an out-of-network provider, you’ll have to pay the provider. Then you have to file a claim to get the PPO plan to pay you back.
- More freedom to choose your health care providers than you would in an HMO
- Out-of-pocket costs you can control
- A moderate amount of paperwork if you see out-of-network providers
- A primary care physician who coordinates your care when you use network providers
- Premium -- With a POS plan, the premium generally stays low because the deductible is high.
- Deductible – You pay a higher deductible if you see an out-of-network provider.
- Copays or coinsurance — Your coinsurance is higher, such as 30%, if you see an out-of-network provider.
- One of these types of health plans: HMO, PPO, or POS
- Higher out-of-pocket costs than many types of plans, but if you reach the maximum out-of-pocket amount, the plan pays 100% of your care
- A health savings account (HSA) to help pay for your care because the money you put in savings is not taxed
- A moderate amount of paperwork
- To manage your own health care or use a primary care provider, depending on the plan
- Premium: The premium is the lowest for a HDHP compared to other plans.
- Deductible: The deductible is high — sometimes more than $3,000 a year for one adult and $6,000 a year for a family. With an HDHP, though, your preventive care is free even if you haven’t met the deductible.
- Copays or coinsurance: The kind of health plan you have — HMO, POS, or PPO — determines which one you pay.
If you have a high-deductible health plan (HDHP), you might also want to have a health savings account (HSA). This is an investment account that grows tax-free over the years. You put money in the account before you have to pay any taxes on it, so you save money. You don’t pay a tax when you spend it either, as long as you spend it on qualified health expenses — health care or products on an IRS-approved list.
HSAs must be paired with an HDHP, which means you must pay a large amount of your health care costs before your insurance pays anything.
What You Can Use the Savings For
- Hospital costs
- Prescription drugs