Understanding Your Health Insurance Options

Health insurance is critical to helping you control your health care costs. You pay health care companies a premium – a set amount of money each month - and you get benefits to pay for your eligible health care expenses. This can include regular doctor checkups or injuries to treatment for long-term illnesses.

You can purchase individual health insurance through the Health Insurance Marketplace on your own or, at no cost to you, we can help you work through your options. although it’s called individual health insurance, you can also find plans to cover your family.

We all know how expensive health care can be. That’s why it is so important to have health insurance so you’re prepared for when you or your family have medical needs. With health insurance you can

• Prepare for the unexpected.
• Access preventive care services – like checkups, which are covered at 100%.

What is Health Insurance Marketplace?

Every health insurance option in the Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on:

• price,
• benefits,
• quality, and
• other features that may be important to you.

Insurance coverage run by private companies

When you shop at the Marketplace, coverage information will be laid out for you. All your costs are stated up front, so you’ll get a clear picture of what you pay and what coverage you receive before you make a choice. Health insurance companies can't refuse to cover you or charge you more just because you have a chronic or pre-existing condition, and they can’t charge more for women than for men.

You may save on your monthly premiums

When you apply for coverage in the Health Insurance Marketplace, you’ll find out if you qualify for a premium tax credit to help lower your premium, which is the amount you pay each month to your insurance plan. The amount of your premium tax credit depends on the estimated household income for 2019 that you put on your Marketplace application.

Coverage falls into four categories

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 out-of-pocket costs —the total amount you’ll spend for the year if you need care. The categories are

• Bronze
• Silver
• Gold
• Platinum

The Marketplace also offers "catastrophic" policies to people under 30 years old and to some people with very low incomes.

Balancing monthly premiums with out-of-pocket costs

As with all health coverage, you will still have to pay a monthly premium.

• Premiums are usually higher for policies that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold policy, you'll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.
• With a Bronze policy, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care.
• Platinum policy will likely have the highest monthly premiums and lowest out-of-pocket costs.

The policy will pay more of the costs if you need a lot of medical care.

In general, when choosing your health coverage, keep this 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

Health Insurance Plans Available on the Marketplace

There are different types of Marketplace health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network. Here is an overview of the types of marketplace plans available to you.

Types of Marketplace plans

Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.

Some examples of plan types you’ll find in the Marketplace:

• Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
• Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
• Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
• Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

For more information about the different options visit www.healthcare.gov

There are pro’s and con’s for each option. It’s important to select the right option based on your needs.

Understanding the Affordable Care Act

There is much confusion around the Affordable Care Act (ACA) and the Health Insurance Marketplace. 

Here is some information to help you understand it a bit better.

The ACA is a law that guarantees everyone with minimum essential health care coverage. You can’t be denied ACA health insurance coverage because of a pre-existing health condition and you can’t be charged more for your plan because of it. 

It’s important to know what’s required under the ACA. Here’s what you need to know as you get started:

• Open enrollment, from November 1 to December 15 is your time to buy health insurance.
• In some instances, you can get tax credits to help you pay for your health insurance.

Most everyone needs to have health insurance

When you’re looking for health care coverage, check the health plans you’re considering to be sure it says it meets “ACA minimum essential coverage.”

There are several ways to buy health insurance:

• Your employer
• Health insurance companies
• Health Insurance Marketplaces 

Keep in mind

• Open enrollment is your time to buy health insurance.
• Open enrollment is a yearly time period set by the ACA. It’s your time to shop for individual health insurance and purchase a plan so you won’t pay a penalty at tax time.
• If you miss this window of time to purchase a plan, there are some exceptions called Qualifying Life Events that let you buy a plan during a Special Enrollment Period. 

In some instances, you can get tax credits to help you pay for your health insurance

Depending on your family situation and annual income, you may be able to get a tax credit to help offset your health insurance costs. You can visit Health Care to see if you qualify for a tax credit before you start buying your plan.

Call us at 210-986-7103 or click on one of the buttons below to meet with one of our licensed insurance agents for guidance in selecting the right policy for you and your family. There is no cost to you for our help.