How to compare and select a health insurance plan?

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How to compare and select a health insurance plan?

This is the most common question I get as an insurance agent. And that is my job to help you! In this video, I will share all you need to know in order to make an educated decision while shopping for health insurance plans. I will also give valuable tips, so keep watching until the end! You can also refer to other videos that I recently posted. For example in one of the videos I explain the difference of EPO’s, PPO’s, HMO’s and POS plans. By knowing these things, you will be able to navigate and compare plans with confidence.

O.k. so let’s start with the basics:

1. There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care. There is also a catastrophic plan for those that qualify (usually for those who are under age of 30)

 Each level pays a different portion of your health care bills. Grouping plans this way makes it easier to shop for insurance. For example, the top-of-the-line plan is “Platinum.” It pays the highest portion of your health care bills It also costs the most. The basic plan is “Bronze.” It pays on average 60% of your health care bills and costs the least.

Let’s start with Catastrophic plans:

This is a minimum coverage plan for those who qualify.

• Minimum coverage plan: If you are under 30, you may be able to buy an additional health insurance plan option called minimum coverage plan. These plans usually have lower premiums and mostly protect you from worst-case scenarios. There is one very important thing that many consumers do not know, and end up overpaying for their health insurance. Those who have minimum coverage plans do not qualify to receive premium assistance (also known as Advanced Premium Tax Credits).
• Minimum coverage plans usually cover three doctor visits or urgent care visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until you reach the out of pocket maximum

Here are a few reasons why you might consider this type of plan:

You are under age 30.

You are comfortable with a high deductible plan.

You are in good health and typically use very few medical services in a year.

Your goal is to comply with the Individual Mandate, avoid the penalty and get health insurance in the cheapest way possible.

• Bronze: These are usually the high deductible plans. On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent. I will go over the details for this plan shortly
• Silver: Silver plans are the most popular ones on the market so far! On average, your health plan pays 70 percent of your medical expenses, and you pay 30 percent. 
  
  In some cases, individuals may qualify for an Enhanced Silver plan. This means that when they choose a Silver plan, they have – based on their income – enhanced out-of-pocket savings through lower copays, coinsurance and deductibles. Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan. These plans are only available on the exchanges! Feel free to reach me and I’ll help you understand if you qualify for enhanced silver plans.
• Gold: On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent. This plan does not have a deductible.
• Platinum: On average, your health plan pays 90 percent of your medical expenses, and you pay 10 percent. This plan does not have a deductible.

And, now let’s take a look at a comparison of plans for year 2018:

Here are the metal categories and coverage for year 2018. There are a few things to remember: Benefits shown in blue are not subject to any deductible. White corner = subject to a deductible after first three visits. Copay is for any combination of services (primary care, specialist, urgent care) for the first three visits. After three visits, they will be at full cost until the medical deductible is met.

So, let’s take a closer look:

As I said, for bronze plans- you don’t pay the deductible for the first 3 visits. The lab is $40 and is not subject to deductible. The Annual Wellness Exam (preventative) is included at no extra cost. The copay for the primary care visit and urgent care is $75 and specialist visit is $105. This might be a good plan for those that are healthy and rarely go to the doctor. Obviously, if you need more care, you will have to pay more out of pocket. The maximum out of pocket you pay is $7,000 for one individual or $14,000 for the family.

Let’s look at the Silver plan

-          The silver plan has a lower deductible. There are no restrictions on how many times you can visit the doctor. And again, the area that is highlighted in light blue is not subject to deductible. You will pay deductible mostly when you are hospitalized. I will add the detailed summary of benefits under the video for the full description once available.

The gold plan has no deductible. The copays and coinsurance are lower than those for the silver plan. This plan costs more each month, but the insurance pays on average 80% of your medical cost and you pay the rest.

The platinum plan has no deductible. The copays and coinsurance are lower than those for the gold plan. This plan costs more each month, but the insurance pays on average 90% of your medical cost and you pay the rest. Obviously the platinum plan has the highest premium each month. If you are healthy and rarely go to the doctor, it might not be a good idea to buy the most expensive plan on the market, right?

Now, as I said in the beginning of the video, I’ll share some secrets with you about selecting a health plan that will fit your needs and saving money at the same time!

Here are some Tips for choosing your plan
So how do you decide which plan is right for you? Start by thinking about your past and future medical bills. For example, let’s say you’re healthy most of the time and don’t expect to need costly medical services during the year. Then, a Bronze plan that has lower price tag and pays for a lower portion of your eligible medical bills may be a good choice for you.      

On the other hand, let’s say you know you have a medical condition that will need care. Or you have an active family with children who play sports. Then, a Gold or Platinum plan that pays for more of your medical costs may be better for you.

Also, it is very important to:

·   Look at the summary of benefits for any plan you’re seriously considering. This document tells you what medical services the plan pays for and, perhaps more important, those it does not pay for.

·   Make sure you like the plan type. For example, a health maintenance organization, or HMO, will require you to have a primary care doctor and get referrals for any specialists you want to see. A preferred provider organization, or PPO, will give you more leeway in choosing doctors.

·   Check the plan’s provider network directory to make sure your primary care doctor is listed, if you want to keep that doctor. You can also call your doctor’s office and ask whether they accept the specific plan you’re considering.

·   Check the plan’s drug formulary, which is the list of covered drugs, to make sure any prescription medications you take are included.