What insurance is right for me?
Oct. 1, 2013, marked the opening of the health insurance marketplaces and a big change in the way that Americans shop for and buy health insurance.
Through the online health insurance marketplaces you will be able to:
- See what qualified health insurance plans are available in your county
- Review all of these plans based on price, benefits, quality and other features that are important to you
- See exactly how much the plans cost
- Find out if you qualify for tax credits to help you pay for your insurance
- Sign up for the plan that is best for you, your family or business
- Get contact information if you want to enroll in the plan of your choice by phone or speak with a marketplace navigator
All information is intended to be presented in easy-to-understand language and all plans are intended to offer quality healthcare at a reasonable price. Plans purchased through the marketplaces take effect Jan. 1, 2019. Plans purchased through the marketplaces during open enrollment for 2019 starting Nov. 1, 2018, through Dec. 15, 2018, take effect beginning Jan. 1, 2019. Open enrollment ends on Dec. 15, 2018. If you miss the open enrollment on your state's health insurance exchange, you won't be able to sign up for coverage unless you qualify for a special enrollment period.
Getting ready to shop
It's possible that you have never had to shop for health insurance before and don't know where to begin. To help you get ready, we have developed the following tips:
- Learn the lingo - Make sure you understand how insurance works, including things like deductibles, out-of-pocket maximums and copayments.
- Find your tax return - Many people will be able to qualify for a tax credit. You'll need income information found on your tax return to find out if you qualify.
- Set your budget - There will be plans to meet a variety of needs and budgets.
- Talk to your boss - Find out if your employer plans to offer health insurance, especially if you work for a small business.
- Call for help - Geisinger's Trusted Advisor healthcare reform information line provides you with access to knowledgeable staff who can provide you with real-time answers to your questions. To reach a member of our staff, call 855-849-1510 Monday through Friday from 8 a.m. to 5:30 p.m. You can also inquire about setting up an appointment with a certified application counselor in person to assess your needs and assist you with enrollment through the Marketplace.
What to consider when buying health insurance either through the Marketplace or individually
When shopping for health insurance, it's important that you know how your plan works, what's covered, what isn't covered, what doctors and hospitals you can visit and what it's going to cost. Getting answers to the following questions will make it easier to compare plans and to make an informed decision.
- What will it cost?
The monthly premium is usually the first thing people look at. But don't be fooled by a plan's low monthly rate. You should consider other out-of-pocket expenses for healthcare, such as deductibles, coinsurance and co-payments.
- Is there an annual out-of-pocket maximum?
That's the most you have to pay each year for most of your covered services. When you reach the maximum, you do not have to pay most out-of-pocket costs, such as deductibles, copays and coinsurance, for the rest of the year. It does not include your premiums.
- Is your current doctor or hospital in the plan's network?
Be sure to check out your plan's list of providers to make sure there are doctors and hospitals conveniently located near you. And if you already have doctors or specialists you like, you may want to be sure they are on the list.
- How are doctor visits covered?
If you go to the doctor often, you may want a plan that covers unlimited visits at a predictable cost. If you don't go often, you should consider a plan that only covers a few visits a year.
- What kind of plan is it?
Health maintenance organizations (HMOs) are often a more affordable and predictable option; however, you are required to access all non-emergency services through a provider network of physicians and hospitals. Preferred provider organizations (PPOs) are frequently more expensive, but give you the freedom to access care outside of their network at a higher out-of-pocket cost.
- Does it include dental, vision or prescription drug coverage?
Not all plans include the same benefits. Make sure you take a look at the plan's coverage options to be sure it provides for the services you need.
Be sure to ask around. What is the reputation of the company? What do your friends and family members think of the company? Their opinions may provide valuable insight into whether the plan is right for you.
Choosing the right health plan is a big decision. By knowing more about the differences between plans and how they work, you'll make a well-informed decision that best meets your needs.