How To Buy Health Insurance. An Introduction To Healthcare Coverage

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1 How To Buy Health Insurance An Introduction To Healthcare Coverage

2 Table of Contents What Is Health Insurance? How Do I Get Health Insurance? When Can I Get Health Insurance? What Terms Should I Know? What Are My Plan Options? Which Benefits Are Most Important to Me? How Do I Pick A Plan? Why Use Insurance Clarity?

3 What Is Health Insurance? Health insurance is a contract between you and the insurance company you ve chosen. You pay a certain amount each month to your health insurance provider, and your insurance provider agrees to pay the greater part of your medical costs for preventive, routine, and emergency care. After all, life is unpredictable. Your healthcare shouldn t be. When you find the right coverage, you ll never miss out on life s best surprises! 2

4 How Do I Get Health Insurance? Since the Patient Protection and Affordable Care Act (ACA) was approved in 2010, it has expanded health insurance options for Americans. Now you can buy health insurance through one of five ways: Insurance Agent Marketplace Your Employer Public Program COBRA A licensed broker who helps you find a plan Government websites that let you shop for plans Insurance provided by your employer Medicaid, Medicare, CHIP, etc. Temporary insurance if you lose employersponsored coverage What s the best way to get healthcare coverage? That depends on your needs. Here s a comparison of the benefits each option offers: Options Insurance Agent Marketplace Employer Public Program COBRA Affordable Plans Available To Anyone Most Plan Options One-On-One Guidance A licensed, third party insurance agent works with you one-on-one to pick an affordable plan for you and your family. When you shop for insurance through an independent agent, you save time and money! 3

5 When Can I Get Health Insurance? Due to new requirements made by the Affordable Care Act, you can only get health insurance during one of two time periods each year: Open Enrollment Special Enrollment A set period of about three months when you must choose an ACA-compliant health insurance plan for the coming year. Your coverage will begin one or two months after Open Enrollment starts, but not before January 1 of the following year. A period of 60 days when you can get ACA-compliant healthcare coverage, even after Open Enrollment has closed. You can only qualify for Special Enrollment if you have a qualifying life event. Qualifying life events typically include any of the following major life changes: MARRIAGE TURNING 26 GIVING BIRTH ADOPTION MOVING DIVORCE OR SEPARATION JOB LOSS SPOUSE S JOB LOSS SPOUSE S DEATH BECOMING U.S. CITIZEN If you ve had a qualifying life event, you can still enroll in a major medical plan, even outside of the Open Enrollment Period. If the Open Enrollment Period has ended, and you haven t had a qualifying life event, you still have options. You can buy short term plans that offer temporary coverage and limited benefits. These plans are available anytime of the year from insurance providers. However, they do not meet ACA requirements, so you ll have to pay a tax penalty. 4

6 What Terms Should I Know? Primary Care Physician (PCP) A physician who directly provides and coordinates care for a patient. If you have an HMO, you must receive a referral from your PCP before you can see a specialist. You don t need a PCP if you go for a PPO. In-Network Provider A healthcare provider who is part of your plan s network. Typically, your insurance plan will only cover the cost of services you receive from in-network providers. Out-Of-Network Provider A healthcare provider whose services are not covered by your plan. You will usually pay more for out-of-network providers. Premium The monthly payment you make to your health insurance provider in order to maintain your coverage. Premium rates vary based on the plan you pick, and how much coverage you want. Out-Of-Pocket Costs What you pay for healthcare services. These expenses include your copayments, deductible, coinsurance, and any services you receive that aren t covered by your plan. Copayment A payment made to a healthcare provider when you receive medical services. This is typically a fixed dollar amount you pay for each visit. For example, if you have a $20 copayment, you ll pay $20 every time you see a doctor. 5

7 What Terms Should I Know? Deductible The amount you pay for healthcare services for the year, before your insurer pays any part of the medical bill. Your monthly premiums and copayments don t typically count toward your deductible. For any health insurance plan, a lower deductible usually means a higher premium; a higher deductible usually means a lower premium. Coinsurance What you have to pay for a covered service after you ve met your deductible. After you pay your share of the bill, your insurance covers the rest. If you have an coinsurance plan, your insurance will cover 80% of the bill, and you ll cover 20%. Say your bill is $200. Your insurance provider will pay $160, and you ll pay $40. Out-Of-Pocket Maximum The most you will pay out-of-pocket over the year, before your plan covers 100% of covered medical expenses. Say your out-of-pocket maximum is $5,000. Once you ve paid medical expenses up to $5,000, your insurance company pays 100% of any additional medical expenses you have that year. 6

8 What Are My Plan Options? When we talk about health insurance plans that are required under the ACA, we re referring to major medical coverage. These long-term insurance plans provide benefits for most healthcare services you need. There are several different plan types that you can choose from, each with distinct advantages. Below, we ve compared the two most popular plan types: HMO and PPO plans. HMO (Health Maintenance Organization) PPO (Preferred Provider Organization) What It Is Group of healthcare providers that have contracts with HMOs, or have agreed to serve HMO members Your insurance company creates a network of preferred healthcare providers Best Perk Typically least expensive medical coverage More flexibility; most popular option Primary Care Physician (PCP) Required Not required PCP Referral Required Not required Out-Of-Network Services Typically not covered Covered, but it costs more Choice Of Doctors Limited Smaller pool of providers than PPO Not limited Larger pool of providers Premiums Lower monthly premiums Higher monthly premiums Out-Of-Pocket Costs Copayments Lower out-of-pocket costs Minimal copayments Higher out-of-pocket costs Higher copayments (especially for out-of-network services) Deductible Little to no deductible Higher deductible 7

9 Which Benefits Are Most Important To Me? Not all plans offer the same coverage, and no two individuals have the same health concerns. When you shop for health insurance, make sure you find a plan that fits all of your needs. Here s what Americans like you want from their health plan: Andrew Age 59 Jenny Age 25 Rachel Age 29 Kyle Age 37 Tom Age 43 Carla Age 51 My youngest child is turning 26, so he s no longer a dependent. I want to downsize my plan. I lose coverage under my parents when I turn 26. I m healthy, so I want basic coverage. I m having a baby, and I don t qualify for Medicaid. I need coverage for my child. I don t want insurance, but I want to avoid the tax penalty. I need the most basic plan. I lost my job, and I need to find affordable coverage for me and my family. I need a plan that covers treatment for my ongoing health problems. Not sure what you want from a plan? Ask yourself these questions: Do I need to cover a spouse or children? Do I need prescription drug coverage? Do I want to keep my current doctor or find a new one? Do I plan to see the doctor frequently? Do I have any ongoing health needs that require specialized care? How much can I afford to pay each month in premiums? Your perfect plan depends on two factors: which services you need covered, and how much you want to pay for coverage. With careful research and expert advice, you ll find the best possible plan for you and your family. To get started, let Insurance Clarity put you in touch with an agent today! 8

10 How Do I Pick A Plan? First, Compare Your Options With Insurance Clarity 1. Enter your zip code and basic personal information on Insurance Clarity 2. Prepare a list of questions and health needs you want covered 3. Receive a call from an agent provided by Insurance Clarity 4. Discuss your plan options with an agent 5. Pick a plan, and apply for coverage! When You Talk To An Agent, Have This Information On Hand Names, Social Security numbers, and birth dates for you and dependents you want to cover Your income tax information from the previous year If you re currently covered, information about that coverage Before You Decide On A Plan, Ask Your Agent These Questions Are my current doctors in this plan s network? Can I keep the doctors I have now? How much would I have to pay to see a doctor? How much would I have to pay for my prescription medications? 9

11 Why Use Insurance Clarity? Health insurance can be very confusing! With Insurance Clarity, you re never alone. We ll connect you to experienced agents who know the ins and outs of the healthcare industry. They ll work with you one-on-one to compare your options, and choose a plan that fits your budget and health needs. Plus, help is free! It costs you nothing to search for a plan through Insurance Clarity. Here s how to contact us for personalized care: Call Talk to a licensed agent at We re open during regular business hours. Browse Visit us at to get free health insurance quotes, compare plans, and review our blog. We work hard to keep you informed! Chat Get online help in real time with our live chat option. With Insurance Clarity, you can start shopping for health insurance TODAY! 10

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