December 16, 2017

Only 28 Days to Chose A Health Insurance Plan

Are you ready for filing your income taxes this year? Have you all your papers together? Did you get health insurance or will you pay the penalty when you file your tax return?

You still have 28 days to get health insurance as open enrollment period is till February 15th, 2015. The Affordable health Care Act (or Obamacare) requires everybody to have health insurance for 2015.  At the moment there are 40 million Americans that have not yet enrolled.

Many people do not have the financial means to purchase health insurance. In the past, they just did not buy it, and when they were sick they often could not pay for the treatment in the emergency room or hospital. Fair enough, many people that did not have insurance paid their doctor’s visit, medication and any surgery or clinic stay.

Either way how you think about this law, health insurance is required, just like having car insurance and home insurance.  So what is it about?

 

Employer Sponsored Insurance

The ACA law requires employers that have more than 50 full time employees to offer health insurance. Luckily, many companies fall in this group. People that work for these employers usually have an option out of two or more plans. Depending on their family situation they can choose the one that best fits their needs. However, if  an employee does opt out of any plan offered, and would get a health plan on the open market, they will not be able to get a subsidy, even if they would qualify.

 

Health Insurance Exchange

If you work for an employer with less staff or who has cut your hours to make you a part time employee, you need to look on the federal, state or private market place to find affordable health insurance. You can either go to an insurance agent or to a local community organization that has counselors to assist in navigating the websites and pick a plan. But you need to be mindful that these might advise you to purchase a plan that is offered by the sponsoring insurance provider.

All states and the Federal Government have their own websites where you find all plans offered. This can be a daunting task if you are not well informed. There are different plan tiers, deductibles and benefits that vary and numerous insurance companies to choose from. Depending on your family situation you may qualify for a subsidy, but how much would you get? And if your income is below a certain amount, you could also get assistance in out-of-pocket expenses. Let me help you get a better understanding on how to determine what plan you need.

 

How to get the best plan?

You need to consider a few things when choosing a health insurance plan.

–        First, get your total family income for 2014 by either taking the details from your W-2 or the last paycheck of the year.

–        Next, how many people are in your family that need to be covered.

–        Then, you need birth dates of every one.

–        Lastly, I would look at my healthcare expenses for the years 2013 and 2014, so I can estimate the amount that I have to budget.

The number of people that need insurance and your total income control if you get a subsidy. Below is a chart that gives the income limits for a lower premium.

 

2015 wage limits for subsidy

2015 wage limits for subsidy

Plans in the market are grouped into 4 categories: Bronze, Silver, Gold and Platinum. In order to qualify for a subsidy, you have to purchase a Silver health insurance plan. Usually, these plans have a lower deductible that the Bronze plans.

 

The question now is:

how much health care expenses will I have in 2015 that warrant to take a Silver Plan with a higher premium, but a lower deductible and maybe qualify for a subsidy?

 

High Deductible?

When you are a healthy person and you do not have children, then you probably could choose a plan with a high deductible. However, when you have children, your health care expenses could be quite different. Looking back at the total cost for health care in 2013 and 2014 will give you an idea of how much you will spend in 2015. If it is less than the deductible in the Silver plan you could take a Bronze plan with a lower premium and save money that you can use towards out-of-pocket expenses. But if it is not substantially more then you could compute the savings of a bronze plan for the year and see if you are better off purchasing a Silver plan.

As I mentioned before, every person’s situation is different and you definitely should look ahead on what is happening in 2015. If you plan to get pregnant, or have a surgery that is necessary for your health, then you need to take this into consideration.

All plans cover the same preventive care that is free of charge even if you have not yet met the deductible. Vaccinations, screenings for cholesterol and high blood pressure, mammograms and other tests are free. See the full list here. Only caveat is that these services need to be performed in-network.

 

High Expenses?

For those that do not qualify for Silver plan with lower out-of-pocket expenses, you can reduce cost by taking a supplemental plan that gives you access to a nurse 24/7/365 by phone or you can talk with a doctor for just $5. This will save on high unnecessary emergency room visits or long wait times to get a doctor’s appointment. Reports from the Centers for Disease Control and Prevention find that more than 50 % of ER visits do not need treatment within an hour. And according to another report 76% could have been treated better at other outpatient care facilities.

 

My recommendation:

If you are ready to purchase health insurance now I recommend that you check out this private members only market place, which has dedicated licensed brokers to help you navigate the insurance choice options.

If you are an owner of a small business that is looking into offering health insurance, please contact me for any assistance.

I realize while writing, that there is so much more that influences a thorough decision for choosing a health insurance plan. I do not want to make this one lengthy post, thus I will talk about the benefits of a high deductible plan in my post next Sunday. Stay tuned for Health Insurance – Part 2.

Feel free to get in touch with me about this post or to leave a comment below. Let me know if this information was helpful for you.

 

 

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