How Do I Pick the Right Health Insurance Plan for Me, or My Family?
First, Ask Yourself 2 Questions
Does anyone have any major pre-existing conditions?
First, determine if you or anyone else that needs coverage has any MAJOR
pre-existing conditions. These can be things like heart disease, history of stroke, recent history of cancer, or diabetes. Smaller conditions like high blood pressure or cholesterol should not be taken into consideration.
Will I receive a Tax-Subsidy?
Second, see if you recieve a subsidy, or tax credit. This money that the federal government will give you towards your monthly premium, and even in some cases, your detuctible and co-pays, to make them lower and more affordable.
Your health insurance tax credit is based on your age, annual househould income, and number of people in your household, which is basically the number of people you claim as spouse or dependents on your income tax return. Some people will recieve large tax credits, while other will recieve little or no tax credits.
Below is a chart to help you determine if you get a subsidy. If you make between 100% and 400% of the poverty limit, you will qualify for a subsidy and should check out an ON-EXCHANGE health plan.
What Plan is right for me?
After you've asked yourself the first 2 questions and determined whether you have a major pre-existing condition or get a tax subsidy, consider these scenarios:
Scenario 1: I have major pre-existing conditions OR I am receiving a large tax credit, OR both.
If you are getting a large tax credit or have a major health condition that needs to be covered, on-exchange insurance plans are probably the best option for you, as your monthly premiums will be lower and more affordable. In addition, your deductible and co-pays are also lowered to make them more affordable. On-Exchange plans are frequently referred to as "Obamacare", and cover all pre-existing conditions.
If you qualify for a tax subsidy, you can only use it towards On-Exchange (Obamacare) plans. You cannot use it towards an Off-Exchange or Health Sharing plans!
Scenario 2: I recieve a small tax credit, OR no tax credit at all, AND I am healthy with only minor pre-existing conditions
When you get little or no tax credit, and are relatively healthy, then off-exchange health plans or health sharing are probably better options for you. There are plans through a health insurance company such as UnitedHealth Care, or health sharing plans through a sharing organization like Altrua. They will be more affordable
What if Off-Exchange Plans are Better for Me
Coverage through an insurance company
Coverage through a
non-profit organization or ministry
Health Insurance vs. Health Sharing Plans
If off-exchange plans are better for you, you have the option of traditional health insurance or Health Sharing plans. Both types of plans are similar in the things they cover, and most doctors will accept either type of plan. When considering health insurance and health sharing, it ultimately comes down to what option is giving you the most bang for your buck, as well as what you are comfortable with.
For an extended discussion, see our video on health sharing, but in the meantime, here is a quick summary.
Traditional health insurance plans are similar to what you are used to if you've ever had coverage through work. They are usually run by large, well known companies like UnitedHealthcare, Aetna, Cigna, and Blue Cross/Blue Shield. They have things like co-pays, deductibles, and monthly premiums (discussed below) that you pay to the insurance company.
As discussed above, traditional health insurance falls into two categories;
1) On-Exchange (otherwise knows as ACA or 'Obamacare' plans) and
Health Sharing Plans, an Alternative to Health Insurance
If an off-exchange plan best fits your needs, a new alternative may be a health-sharing plan. Unlike insurance, they they are not governed by insurance regulators, and can be a little more creative in how they cover people.
They are not run by companies, but rather non-for-profit sharing 'ministries' that in many cases are Christian-based. While you don't have to be a Christian to get a plan, many do require a belief in a 'higher power' to be able to join.
Most of these plans are designed for healthier individuals & families, and do not cover major pre-existing conditions, at least not for a while. Because of this, however, individuals and familes often pay a much lower monthly cost for these plans, sometimes as little as half as much as a traditional health insurance plan.
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Comparing health plan networks, and
why it matters
Types of Health Plan Networks
Your plan's network is the list of doctors and hospitals that you can use with your insurance plan, whether it is an on-exchange, off-exchange or health sharing plan. There are four main types of provider networks, listed below:
HMO "Health Maintenance Organization"
Strictly local or state-wide network of doctors and hospitals, with a primary care doctor ordering tests and coordinating care. Referrals are necessary to see specialists.
PPO "Preferred Provider Organization"
A nationwide network of doctors and hospitals, with additional local doctors as well. No referrals needed to see a specialist, and out-of-network care is also covered, at slightly higher costs.
EPO: "Exclusive Provider Organization"
Kind of a hybrid between HMO's and PPO's, they keep you confined to a more local network of doctors and hospitals, but you do not need referalls to make appointments and see specialists.
Ideally, you would always prefer a PPO network, as it gives you the most amount of provider options with the least restrictions. Sometimes, they can be expensive, depending on the situation. If you have a doctor now that you want to keep, be sure to check that he's in your plan's network.
The Last Step: Comparing the Actual Benefits
When comparing your final options, it is important consider how much money it costs when it comes time to use your benefits. When you get sick, there are things to consider such as the deductible, which is the amount of many you must spend before your insurance will pay a claim.
For instance, if a major accident occurs, and you end up in the hospital, how much is that going to cost you? Some deductibles are as high as $15,000.00, or as low as $0. If you have a higher deductible, do you have supplemental coverage to help in a worse-case scenario? There are co-pays on prescriptions, per-visit fees to the emergency room, and urgent care or a regular doctor visits.
Do you see a specialist a lot? Then the cost of a specialist visit will be important. These can all range in price depending on your coverage.
Compare Plans & Quotes
Of course, everyone wants the cheapest plan. But it's not that simple. One of our nerds can walk you through the entire process, helping you compare the options and quotes available to you. We're insurance nerds, it's what we like doing.
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