Plan Benefits Usually Outweigh the Costs of Health Insurance
Protect yourself and loved ones when the unexpected happens.
Written by: Andrew Hall.
Health insurance options are different based on several factors, including individual or family, employer (group) provided, whether you need financial assistance. Once you know the type of plan you need, then you can begin to decide your cost and coverage options. Because each plan has its own specifics, it’s important to consider how plans can change in cost, accessibility, and range of coverage.
Health insurance should never be an impulse purchase. There are several things to consider, including health, budget, and provider networks. Here’s a list of considerations to get your research started:
- Individual or family? An individual health plan covers one person. A family plan covers two or more people, like children under 26 and a spouse. Premiums and deductibles cost more with family plans, and they can be twice as much as individual plans.
- Comprehensive or limited-benefit? These are types of coverage. Comprehensive health insurance is also known as “major medical” health insurance. Major medical plans cover a wide range of services. The Affordable Care Act (ACA) regulates minimum standards, and every major medical plan must cover ten essential benefits. Limited-benefit plans do not have standards for coverage. They’re often called “supplemental” insurance. These plans are restrictive, but with premiums lower than major medical plan premiums. Limited-benefit plans are not regulated by the ACA.
- Day-to-day health needs? Most people’s decision for coverage comes down to cost. But if you take medication, or have other preventive concerns, consider prescription drug coverage or dental. The cost of medications can be significant if not covered — sometimes a few dollars with, versus hundreds without.
- Provider Network? If you have a regular primary care physician, it’s important to know if they’re in a plan’s network. Knowing if your providers and hospitals are in-network can help you avoid out-of-pocket costs.
- What’s your budget? The monthly cost you will pay to have insurance is called your premium. If you want to keep your premium low, you do have control of your deductible, copay, and coinsurance. Each of these determines the costs you and the insurance company share for medical services.
- Special Circumstances? You never know when you may get sick or when your insurance needs may change. If you experience a qualified life event (QLE) you are eligible for a special enrollment period (SEP). Life events like a loss of coverage, if you move to a different state, or have a baby, among others, are considered a QLE. You can be granted 30 to 90 days, depending on the QLE, to change or add insurance outside of the annual enrollment period — this is the SEP.
If you don’t have health insurance, you may be putting your health and finances at great risk. There are several available options to make health insurance more affordable, including subsidies and Medicaid. The ACA’s ten essential benefits provide coverage for preventive care, which may help treat a disease before it becomes an emergency. If you don’t have health insurance, your only access to treatment may be the emergency room (ER), which can be ten times the cost of a primary care doctor or your entire insurance policy.
Depending on your situation, there are several ways you can shop for, and enroll in, health insurance.
- If you do not use your employer’s group insurance policy, but think you may be eligible, ask if you are eligible.
- You can purchase your health insurance directly from a private insurance company or through the Health Insurance Marketplace.
- If you need financial assistance, check with your state  to find out if you qualify for programs such as Medicaid or Children’s Health Insurance Program (CHIP).
- Your state may provide its own health insurance plan.
- If you lost your employer-sponsored insurance, you can shop the Marketplace or enroll in temporary coverage under COBRA.
What are the ten essential benefits?
- Prescription Drugs
- Pediatric Services
- Preventive and Wellness Services and Chronic Disease Management
- Emergency Services
- Mental Health and Addiction Services
- Pregnancy, Maternity, and Newborn Care
- Ambulatory Patient Services
- Laboratory Services
- Rehabilitative and Habilitative Services and Devices
How can I lower my health insurance costs?
You never know when you may get sick or have a health emergency, but you’ll want insurance when it happens. There are ways to control your costs, here are a few:
- Find out if you qualify for the Advanced Premium Tax Credit.
- Shop for an HMO. You limit your out-of-network care with an HMO, which means you will pay less for your health insurance.
- Choose a High Deductible Health Plan (HDHP). These plans are great for healthy individuals because routine visits are covered. Choosing a high deductible will lower your monthly premium, but spending your deductible is expensive in an emergency.
What is catastrophic coverage?
Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself.