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Do you need to buy health insurance, but you aren’t sure where to start? HealthMarkets offers plans from recognized insurance companies across the United States. HealthMarkets can help you find the best health insurance plan based on your unique financial and health needs at no additional cost to you

What Is Health Insurance?

Health insurance is a contract between yourself and an insurance company. In exchange for regular payments (premiums), the health insurance company agrees to help you pay for medical and surgical expenses.

The way that insurance companies pay for these medical expenses varies and often depends on the type of health insurance plan. For example, the insured (the owner of the health insurance policy or the person with the health insurance coverage) could pay medical costs out of pocket and then be reimbursed for covered services up to a certain amount. Or, the insurance company could agree to pay a certain amount of covered expenses up front to the provider.

What Are the Different Types of Health Insurance Plans?

The most common types of major health insurance plans include: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service Plans (POS), and High-Deductible Health Plans (HDHPs) with or without Health Savings Accounts (HSAs).1 Each plan is outlined below:2

Health Maintenance Organizations (HMOs): 

  1. Policyholders receive care from a specified network of doctors, hospitals, and healthcare providers.
  2. You must receive care within your network, giving you the least freedom of other plans.
  3. You pay the full price out of pocket from care received from an out-of-network provider.
  4. A primary care physician coordinates your care and refers you to specialists when necessary. These referrals are required by most HMOs, except in the event of an emergency or routine in-network visits to a gynecologist or obstetrician.

Preferred Provider Organizations (PPOs): 

  1. You have the flexibility to see any doctor or provider you choose.
  2. PPOs still have a network of doctors who charge less for plan members.
  3. Visiting an out-of-network provider usually costs more than staying in-network.
  4. Referrals to specialists are not required.

Point of Service Plans (POS): 

  1. This is a mix between an HMO- and PPO-style health insurance policy.
  2. You have more choices than with an HMO.
  3. You may need to select a primary care provider and receive a referral to see a specialist.
  4. You have the choice to use doctors, hospitals, and other providers that are not in your health plan's network.
  5. You will have to pay more for using out-of-network providers.

High-Deductible Health Plans (HDHPs): 

  1. This has a higher deductible than most health plans (the annual amount you are responsible for before your health plan pays its part for covered healthcare services), but it also has a lower monthly premium (the amount you pay every month for your health plan).
  2. You generally pay less each month, but when you need healthcare, you pay more out of pocket before you get help covering your medical costs from the insurance company.
  3. These follow the HMO, PPO, or POS model.
  4. HDHPs can be paired with Health Savings Accounts (HSAs). HSAs allow you to save money tax free for use on qualified medical expenses.3

Once you determine how a health insurance plan fits your lifestyle, you can decide the level of coverage you need. The level of coverage is organized by the level of benefits each plan offers:4

Metal Level

Platinum 

Gold

Silver

Bronze

Percentage of medical costs covered (average) 

 90%

 80%

 70%

 60% 

You pay

10%

20%

30%

40%

Why Do I Need Health Insurance?

Think of health insurance as you would homeowner's or car insurance: You never know when an accident will happen, so it’s a good idea to be prepared for the unexpected. 

The average cost of a three-day hospital stay is around $30,000.Health insurance can help with the hospital bill and many other related medical expenses.

Primary or preventive care can be offered by health insurance (including but not limited to vaccinations, cancer screenings, mammograms).Health insurance can allow you to take a proactive approach to your health and help you develop a clear plan for future wellness. 

Am I Required to Have Health Insurance?

No, you are not required to have health insurance unless you live in a state with an individual health insurance mandate.As of 2020, these states included California, Massachusetts, New Jersey, Rhode Island, and Vermont, as well as Washington, D.C.8

The Affordable Care Act (ACA) requires that health insurance policies include a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories:9
  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventative and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Benefits of the Affordable Care Act 

While most Americans understand the importance of health insurance, there are still many who go without it. As of 2019, 10.9% of nonelderly American adults were uninsured.10

The ACA was signed by President Barack Obama in March 2010 to “make healthcare more affordable, accessible and of a higher quality. This includes those who were previously uninsured, and those who had insurance that didn’t provide them adequate coverage and security.”11

How Do I Know What Health Insurance Plan is Right For Me? 

Are you buying individual health insurance?

Understand your needs. Any ACA-qualified plan you purchase will cover essential health benefits, but some services or office visits may not be covered. Think about how many doctor visits you have each year, whether you’ll need surgery or major procedures in the future, and whether you currently take or will need to take prescription medications. 

Compare the market. The health insurance world can be complex. HealthMarkets can help you easily compare health insurance plans and rates to simplify your decisions. 

Are you 25 or younger?12  

  1. Find out if you’re eligible to stay on your parent’s plan. The Affordable Care Act allows individuals under the age of 26 to maintain coverage through their parent’s health insurance plan, even if they are no longer in school, do not live with their parents, or get married.
  2. Check your eligibility if your parents are retired. Retiree-only health insurance plans aren’t required to cover children under 26, so confirm with your parent’s plan whether you are eligible for coverage.

Have you lost your job? 

  1. Sign up for COBRA. If you were terminated by an organization with 20 or more full-time employees that offered health insurance, COBRA enables you and your dependents to stay on the company’s health plan for up to 18 months after being terminated.13
  2. Consider buying individual health insurance. HealthMarkets can help you compare health insurance plans. Talk with a licensed health insurance agent, at no cost to you, and begin looking for coverage for you and your loved ones. 

How Much Is Health Insurance Going to Cost?

According to a 2020 poll conducted by NBC News and the Commonwealth Fund, approximately a quarter of likely American voters said they were very or moderately worried about their ability to afford healthcare over the following 12 months.14

It is critical that you fully understand how much you will be paying for your health insurance plan and the extent of services and coverage provided. When you are shopping for a policy, look beyond the premium cost and consider other fees you may face, such as the cost percentage of doctor visits. Also make sure you understand your plan’s out-of-pocket maximum for the year, since certain expenses may not count toward that total.

The cost of your health insurance plan will vary depending on the type of plan you select, how often you require care, and the type of services needed. Here are three ways you pay for health insurance:15
  1. Premium: what you pay your insurance company each month for coverage. The amount depends on the health plan you select. Multiply your premium amount by 12 to calculate the yearly cost of your plan. 
  2. Deductible: a set amount that you must pay before your insurance company helps to pay toward your care. Deductibles could be $500, $1,000, or more. 
  3. Out-Of-Pocket Costs in Copayments or Coinsurance: plan costs depend on the number of doctor visits, frequency of prescription refills, and other types of medical services. Copays are a flat fee (e.g., $20 to visit a doctor’s office). Coinsurance is a percentage of costs (e.g., 25% of the cost of a prescription drug).

What Is the Best Way to Buy Health Insurance?

One of the best ways to buy health insurance is by speaking with a local, licensed health insurance agent. Licensed agents can help you evaluate your coverage needs, stay within your budget, and find a plan for you and your family. Call (800) 360-1402 to get started today.

47906-HM-0821

References:
1. HealthCare.gov. Retrieved from https://www.healthcare.gov/choose-a-plan/plan-types/ Accessed on January 22, 2021. 

2. WebMD. June 2020. Retrieved from https://www.webmd.com/health-insurance/types-of-health-insurance-plans#1 
3. IRS. January 2021. Retrieved from https://www.irs.gov/pub/irs-pdf/p502.pdf 
4. HealthCare.gov. Retrieved from https://www.healthcare.gov/choose-a-plan/plans-categories/ Accessed on January 22, 2021. 
5. HealthCare.gov. Retrieved from https://www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/ Accessed on January 22, 2021. 
6. HealthCare.gov. Retrieved from https://www.healthcare.gov/preventive-care-adults/ Accessed on January 22, 2021. 
7. HealthCare.gov. Retrieved from https://www.healthcare.gov/fees/fee-for-not-being-covered/ Accessed on January 22, 2021. 
8. KFF. Retrieved from https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/im-uninsured-am-i-required-to-get-health-insurance/ Accessed on January 22, 2021. 
9. HealthCare.gov. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ Accessed on January 22, 2021. 
10. KFF. November 2020. Retrieved from https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ 
11. DHR. Retrieved from https://dchr.dc.gov/page/affordable-care-act-benefits-expansion Accessed on January 22, 2021. 
12. HealthCare.gov. Retrieved from https://www.healthcare.gov/young-adults/children-under-26/ Accessed on January 22, 2021. 
13. CMS. Retrieved from https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_fact_sheet Accessed on January 22, 2021. 
14. NBC News/Commonwealth Fund. February 2020. Retrieved from https://www.commonwealthfund.org/publications/2020/feb/what-do-likely-voters-think-about-their-health-care 
15. WebMD. September 2020. Retrieved from https://www.webmd.com/health-insurance/estimate-costs-aag#1


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