When the Affordable Care Act (otherwise known as Obamacare) became law, the entire health insurance industry made a massive shift. Insurance plans changed and issues regarding pre-existing conditions were resolved. The problem that exists now is getting enrolled in the right health insurance plan. Whether you use the state or the federal website to enroll, it can be hard to do it right. For good reason, many people choose to work with an independent insurance agent rather than doing it themselves.
If you do plan to enroll in a health insurance plan, here are some basic tips that can help you get signed up correctly.
It is worth shopping around. Don’t assume all plans are the same. Generally, a lower-priced plan will have a higher deductible or higher co-pays, but not in every case. If you tend to use your health insurance frequently, or have a medical condition and know you will need to use your plan, consider the deductible and the co-pays as an important factor in the plan you choose. You will have to pay out-of-pocket until you have met your deductible. The law allows for out-of-pocket caps of $6,600 for an individual and $13,200 for a family.
Decide on a PPO or HMO. A PPO (Preferred Provider Organization) allows you to go to any physician or other healthcare provider within your network without a referral. You can also go to medical professionals outside your network, but may pay more out of pocket when you do. With an HMO (Health Maintenance Network), you will choose your primary care physician from the network, and all of your healthcare needs will be directed by that physician, unless you are injured or seriously ill and go to the ER. None of your healthcare costs out-of-network are covered. If you have a health condition and need to go to a specialist, it will require a referral from your primary care doctor or your visit will not be covered. An exception is for women going to an OB/GYN for routine testing; in this case, here is no referral needed, but that OB/GYN must be in the HMO network.
Like your doctor? If you like the doctor you have, call his or her office and find out what network they are in before you choose your health insurance plan. Doctors are in certain networks, and if you choose the wrong plan, you could be disappointed. The same holds true for hospitals. Is there a high-rated hospital in your area that you want to be able to go to if needed? Make sure you know what network that hospital is part of before you decide.
Find out about tax credits or subsidies. You will qualify for a tax credit when you sign up for health insurance. You may also qualify for a subsidy. Don’t assume that you will get the subsidy every year. If your income changes, you may lose the subsidy, and if you continue to pay at that rate, the health insurance company will expect you to repay it when you file taxes.
Get a local insurance agent. Health insurance can be a complicated subject. It is much easier and simpler to get a local agent to do the hard work for you. It won’t cost you more to go through an agent, but it will certainly make it possible to choose the right plan. A health insurance agent understands all of the details of Obamacare, and they can tell you which plans best match your budget and your circumstances. You can avoid the entire problem when you get an agent to solve it for you!
We are here to help you make the right choice for your health insurance plan. Whether you are searching for a group health insurance plan for a business, an individual, or a family, we know exactly what to do.
We will talk to you and get the facts, and within a short period of time can show you the plans that match your situation. We always keep the cost of the insurance as a primary concern, as we know how important it is for anyone to keep health insurance bills as low as possible. Call us! We would love to talk to you about your health insurance or review your existing policy to see if there is a better plan for you.
It’s the perfect time to remind ourselves to plan ahead for the ones we love.