Purchasing health insurance should be one of the most common-sense decisions you can make. But, the fact is, way too many people still aren’t covered and don’t understand what insurance is or even why they have it. 

Medical Debt is one of the main reasons for bankruptcy in America, and having health insurance helps alleviate that factor from your life.

Do you wear a seatbelt in the car? Why wouldn’t you have insurance to cover when an accident could happen in life, just like a seatbelt it is there WHEN you need it not IF.

There are 3 main solutions:

1. Traditional Health Insurance 
2. Short Term Medical
3. Health Sharing plans

For now, let’s look into standard Medical Insurance

Open Enrollment – 

What’s is this?  You mean I just can just sign up at any time? This is correct,   Unless you are in a special enrollment period you can only sign up or make changes to your plan from Nov 1st to December 15th in most states for a Jan 1st effective date. It’s important to take close note of this period as it’s during the holiday season.  

Special Enrollment Periods

Having a baby? Getting Married? Moving? Losing work coverage from a job transition?, these and a few others are special enrollment periods which allow you to be able to enroll on Traditional Plans during a 60 day period of time. Some require a loss of qualifying coverage due to these events.

Tax Credits/Tax Subsidies:

Based on your annual household income(What you will file for income on taxes)  the state and federal governments have created a way for you to get a tax subsidy, what this does is allows for your monthly premium to be discounted to a lower price. Now it is important for your income to be accurate because come tax season you could be responsible for paying back all subsidies if your income is substantially higher.

Traditional Health Plans and Terms

PPO– A PPO (Preferred Provider Organization) Is a type of Health Insurance plan that allows for you to have maximum benefits In-network while allowing some coverage Out Of Network normally with a large monetary requirement. PPO plans can still be only in state coverage and being out of state typically falls under Out Of Network coverage for larger catastrophic events

HSA– An HSA (Health Savings account) is like a personal savings account, but the money is used only to pay for health care expenses with a Qualified High Deductible Health Plan. These accounts are held through financial institutions like your local bank. These Plans are great once you have finished Baby Step 3!

HMO– An HMO (Health Maintenance Organization) is a type of Health Insurance plan that focuses a lot on preventative care, having a requirement to see your primary care provider (PCP) for any non-emergency based need for a referral before seeing additional recommended specialists/doctors. HMO’s are In-Network only based care, meaning that they do not cross state lines or cover services without a proper referral from your PCP.

EPO– An EPO (Exclusive Provider Organization) Is a type of Health Insurance plan that you can use local doctors and hospitals. There is no out of network care. You do not need to have permission to see specialists.

NETWORK– A network is a large group of physicians, hospitals, and other health care providers that agree to provide discounted medical services to a participating group.

Deductible– The amount of money you are responsible for before your insurance plan starts to pay.

Copay/Coinsurance– A set fee or percentage you are responsible for paying for qualified medical services after reaching your deductible. Coinsurance is the act of splitting the cost of medical services with your health insurance until you hit your Out Of Pocket Max 

Cost Sharing Reduction (CSR): Cost Sharing Reduction provides a discount that lowers the amount you have to pay for deductibles, coinsurance, and copayments. This is based on your income and can only be applied to Silver plans.

Types of Health Plan Options:

Catastrophic Coverage: Catastrophic health plans tend to be the least expensive plans, But are only for the BIG events, they have large out of pocket costs associated with them. Only available in you are under the age of 30 or eligible for a “Hardship exemption”

Bronze: Bronze plans often have the lowest monthly premiums. Bronze plans cover an average of 60% of all your covered out-of pocket costs while you are responsible for 40% until you hit your out of pocket max.

Silver: Silver plans tend to be in the middle of the road when it comes to premium cost. Silver plans cover 70% of cost once the deductible is met, and leaves you with the remaining 30%. This is also where the Cost Sharing Reduction plans mentioned above come into play.

Gold: Gold plans are on the higher end when looking at premiums. They cover 80% of your out of pocket expenses once your deductible is met (if applicable), leaving you to be responsible for 20% until you hit your Out of Pocket Max.

Platinum: Platinum plans are the most expensive monthly premiums. Platinum level plans cover 90% of all covered out of pocket costs after the deductible (if applicable) leaving you to be responsible for 10% until you hit your Out of Pocket Max.

Indemnity Health Plans

An Indemnity health insurance plan is a healthcare plan that allows you to choose the doctor, healthcare professional, hospital or service provider of your choice. An Indemnity Plan helps provide protection against the costs of medical expenses and includes large limitations and caps for continual care.

Indemnity Health Plans are also known as: 

-Traditional Indemnity Plan 

-Fee-for-Service Plan 

Have an Indemnity Health Plan? 

Contact us to review your plan to make sure it fits your current needs!