In the middle of a personal or family health issue, or crisis, the last thing we want to think about is are we covered, and are we covered adequately! This is why, given the high costs of healthcare, it is so important to take care of your insurance and understand how it works from the get-go. Taking the time to be prepared for these inevitable eventualities will allow you to focus your mind on what’s most important – how to get the best care for you and your loved one’s.
This step-by-step guide will help you make sure you’ve got all the bases covered.
What does your plan cover?
When the Affordable Care Act (ACA) took full effect in 2014 it was mandated that all plans offered in the Marketplace must cover the following services:
What are the plan costs?
Your health insurance costs are affected by:
There are four types of plans offered to individuals with different combinations of premiums and out-of-pocket expenses:
Out-of-pocket expenses or “cost sharing” does not include your monthly premium. These costs have to be paid by the individual policy holder. The provisions of these costs are not standardized and can vary from insurer to insurer, again emphasizing the need to get expert advice when considering options.
Only when you reach the out-of-pocket limit will you be fully covered for further expenses.
A high deductible plan would leave you most exposed to these out-of-pocket costs should you or your family become ill or require more expensive treatment. Of crucial importance however, is that you cannot be denied coverage with these plans, and cannot be denied coverage for preexisting conditions.
If you are in good health and have generally been healthy, as an alternative, you could decide to get covered with a short term major medical plan. These plans are generally more affordable, however, enrollees will be subject to a tax penalty. Coverage can be denied for preexisting conditions as underwriting is required and the plans are not renewable or guaranteed.
Health Insurance Subsidy
In terms of the ACA there is a government assistance program to help offset health insurance costs. These subsidies provided in the form of tax credits, are granted on the basis of income and need.
Tax credits are obtained during the application process. It is advisable to talk with one of our experts during this process who can advise you on the most affordable plans to choose from and guide you.
Are your preferred doctors and hospitals in the plan?
All health insurance plans have a network of providers including doctors, hospitals, pharmacies and laboratories.
If you have doctors who are not in your network (the plan you have chosen), your insurance company may not cover your bill, or, you may have to pay a much higher share of the cost. When enrolling in a plan, you will be able to see if your doctor is in the plan network. The enrollment process allows you to search for doctors and hospitals. This can be frustrating as the directories are not standardized.
In order to keep costs low and under control, many insurance providers have smaller or reduced networks. To be absolutely sure that your doctor is in the health plan you want, it may be best to check with their office before finalizing enrollment.
Making sense of health insurance premiums can be very confusing as there are many different products to choose from. There are ACA health plans, short-term medical plans, supplemental health insurance including hospital indemnity, cancer and accident insurance. In addition, there are also the health sharing ministries; you do not want to commit to a policy that isn’t right for you. At PBC Insurance Group we will match you with a professional agent who will listen to you, understand your requirements, and complete the necessary due diligence to make sure that you have the right coverage at the most affordable price.
We embrace a consultative approach with our clients. There is no pressure on you to make instant or ill advised decisions. Our professional agents will give you well considered advice that works best for you.