Health Insurance Shopper s Guide 3 steps to choosing the right health plan for you and your family.

Transcription

1 Health Insurance Shopper s Guide 3 steps to choosing the right health plan for you and your family.

2 Ready to get started? We re here for you online, on the phone or in person. Visit for a quick and free quote Answer a few quick questions and our help me choose tool will show you the best plan choices for you. Talk to a knowledgeable insurance agent at They ll help you find out if you can get a subsidy then find the plan and the provider network that s best for you. Join us for a Health Insurance Seminar Learn how insurance works and meet one-on-one with licensed agents to get your questions answered and find the plan and network that s best for you. To register for a FREE seminar visit /seminars. 2

3 3Steps to SHOP For Health insurance Choosing a health insurance plan is an important decision. We re here to help make it easier to find and sign up for health insurance. Let s get started!

4 Step 1 Get to know how insurance works. When you have a health insurance plan, you agree to pay a monthly bill called a Premium and your health insurance company agrees to share in the cost of your medical care. Here s a look at how you and your health insurance plan may share healthcare costs. Your exact cost share may vary, depending on the plan you pick. You Pay Insurance Pays Penalties for being uninsured Copay: Set amount you may pay to see a doctor, visit an urgent care or fill a prescription. Deductible: Amount you may pay before your insurance starts sharing medical costs with you. How it works: Assume you have a plan with a $1,000 annual deductible so you must pay the first $1,000 of the costs. Coinsurance: This is your share of the healthcare cost after your deductible is met and until you meet the out-of pocket maximum. How it works: Assume you have a plan with 80%/20% coinsurance. That means once you have paid your $1,000 deductible, your insurance will pay for 80% of the costs and you will pay 20% of the costs until you reach your out-of pocket maximum. Out-of-Pocket Maximum: The most you pay during a year before your health plan pays 100% of the allowed amount for covered services. How it works: If your plan has a $4,500 maximum, you ll pay $1,000 for your deductible and an additional $3,500 in coinsurance to reach your out-of-pocket maximum. Once you reach the maximum, you ll still have to pay premiums, but your health plan will cover the costs for covered services the rest of the year so long as you stay in-network. Fees vary by service Remainder of the cost of service $1,000 0% 20% up to $3,500 80% 0% 100% The Affordable Care Act requires most people to have health insurance. Those who don t could face federal tax penalties. These penalties are calculated for each household in two ways as shown below. You have to pay whichever amount is higher Federal Tax Penalties Per household $325 per adult $ per child Up to $975 per household OR 2% of household income 4

5 Step 2 Find out if you can get financial help. Think you can t afford health insurance? There are two kinds of financial help called subsidies from the federal government. These subsidies are meant to help reduce your overall cost of health insurance. Premium Tax Credit This helps pay for all or part of your monthly insurance bill (or premium ) Cost-Share Reduction This helps pay your share of the costs of medical services you may receive such as copays, deductibles and coinsurance We re here to help you If you think you may be able to get financial help, we can help you apply for subsidies through the Health Insurance Marketplace Subsidies are given to individuals and families based on their household income and family size. You may receive subsidies by applying through the Health Insurance Marketplace (healthcare.gov). Here s a look at the net household income levels eligible for subsidies Qualifying Income Levels Number of people in your household Qualify for lower premiums if your annual income is between $29,176 $46,680 $39,326 $62,920 $49,476 $79,160 $59,626 $95,400 $69,776 $111,640 $79,926 $127,880 Qualify for lower premiums and out-of-pocket costs if your income is between $16,105 $29,175 $21,708 $39,325 $27,311 $49,475 $32,914 $59,625 $38,516 $69,775 $44,119 $79,925 There s Also Medicaid Medicaid is a federal government program that provides health coverage for low-income individuals. You can apply for Medicaid coverage at any time of the year. You can find out if you get Medicaid by calling the AHCCCS hotline at

6 Step 3 Pick a plan and pick a network. Pick a plan that fits your budget and lifestyle Choosing the right plan comes down to health and budget. Here are some questions to ask as you pick a health plan: 5 Questions to Consider 1. What plans offer affordable copay amounts for doctor visits? 2. Are my medications covered? 3. Which plans does my doctor take? 4. What deductible is right for my budget? 5. Which plans offer the best value? All of our plans have coverage for: Doctor visits Prescription drugs Preventative care, screenings and immunizations Outpatient care Emergency and urgent care visits Hospital stays Mental and behavioral health care Pregnancy and newborn care Children s dental and vision care All plans are subject to limitations, exceptions, and cost share requirements. 6

7 BCBSAZ Plans for 2015 Here s a look at our plans available as PPO plans across the state and HMO plans in Maricopa and Pima Counties. EverydayHealth Most popular! EverydayHealth may be the right plan for you and your family if you: Want low copays for in-network doctor visits and prescription drugs Need financial protection in case you have an emergency or a major medical issue Want broad coverage, but don t want to pay too much each month CopayComplete $0 deductible in-network! CopayComplete may be the right plan for you and your family if you: Want to know exactly what you will pay if you need a surgery or major medical treatment Want in-network coverage right away without having to pay a deductible first Are willing to pay a little more each month to get predictable costs if a major medical situation arises SimpleHealth Under 30s! SimpleHealth may be the right plan for you and your family if you: Are under age 30 or have met a hardship exemption Are likely to visit your doctor less than four times in a year Want the absolute lowest possible monthly premium, even if that means you may pay more if you do to get medical care Essential Low premiums! Essential may be the right plan for you and your family if you: Are likely to visit the doctor less than four times in a year and stay in-network Are likely to choose generic prescription drugs over brand-name drugs Are willing to pay more if you do need medical services, in return for a lower monthly premium bill Portfolio HSA HSA ready! Portfolio HSA may be the right plan for you and your family if you: Want to pair your health plan with a Health Savings Account Don t expect frequent doctor visits or prescriptions, or Are expecting higher medical costs and want to use a Health Savings Account for its tax advantages Which Metal Level is right for you? Gold Plans Lowest Deductibles/Highest Monthly Premiums Willing to pay more each month for the peace of mind of knowing out-of-pocket costs will be more limited Silver Medium Deductible Amounts/Medium Monthly Premiums Want broad coverage with more moderate monthly and out-of-pocket costs Bronze Highest Deductible/Lowest Monthly Premium Looking for the lowest monthly premium Gold Silver Bronze Monthly Premium Out-of-Pocket Costs $$$ $ $$ $$ $ $$$ 7

8 Pick a network of providers to visit. A big part of choosing an individual and family health plan is picking your healthcare provider network. A network is a group of doctors, hospitals and other medical service providers that agree to provide services to members of a health plan. When you see doctors that are contracted with your plan, they are considered to be in network. Why Network Choice is Important You may be able to save money on your monthly payment (premium) by choosing a smaller network. Your medical costs will be lower if you get care from an in-network doctor. Some plans cover only limited services out-of-network, such as emergencies. 5 Questions to Consider 1. Is my doctor in-network? 2. Are there in-network doctors and hospitals close to where I live or work? 3. Do I often travel outside of my home county? 4. Am I willing to have a smaller choice of doctors and hospitals if it would save me money? 5. Do I need to get care from doctors and hospitals outside of the network? Networks are subject to change. Internal Company data representing BCBSAZ s statewide network only. Does not apply to any other BCBSAZ network. Blue Cross Blue Shield of Arizona Network Choices Our Network options include: Statewide PPO Includes over 90% of the doctors and hospitals in Arizona, including doctors and hospitals in every county Alliance HMO (Maricopa County only) Includes doctors and hospitals from Banner Health, Scottsdale Healthcare and John C. Lincoln Health Select HMO (Maricopa County only) Includes doctors and hospitals from IASIS Healthcare, Dignity Health and Phoenix Children s Hospital Secure HMO (Pima County only) Includes doctors and hospitals from Carondelet Health The Statewide PPO network is available to Arizona residents Maricopa County residents can choose the Statewide PPO or from two Exclusive HMO networks Pima County residents can choose the Statewide PPO or one HMO network 8

9 Open Enrollment November 15, 2014 February 15, 2015 Get Answers. Get Covered. Open Enrollment is the set time period when you can buy individual health insurance plans for yourself or your family. This is the only time during the year that you can enroll in an individual health insurance plan, unless you have a Qualifying Event. Special Enrollment Period If you did not get enrolled during the Open Enrollment Period you can still get enrolled if you have a Qualifying Event. Events include marriage, birth of a child, change of jobs and more. For a list of common qualifying events, visit /sep 9

10 Six Reasons to Choose Blue We know you have many choices today when it comes to health insurance. As you compare health insurance plans, think about what Blue Cross Blue Shield of Arizona offers Trusted experience Trust in a name that has been protecting Arizonans for 75 years, with over 1.3 million customers 1. Great value Members of our plans also get access to convenient account tools and other member programs. The AZblue mobile app and online tools help you manage your account, plus members also gain added value through wellness programs, such as Walking Works TM, savings for gym memberships and more. Healthcare your way With network choices, including a Statewide PPO network with more than 90% of doctors and hospitals in Arizona 1, as well as more local HMO networks with a smaller number of providers in a more narrow area, you can decide what works for you. We make it easy We re here for you every step of the way. Whether you need help finding a plan, applying for subsidies or help finding a doctor, we have people you can talk to. We also have Spanish speaking sales representatives available to assist you too. Freedom to choose Compare plans that fit different needs and budgets. And choosing a local network may offer more savings too. High satisfaction We were rated by J.D. Power as having the Highest Member Satisfaction among Commercial Health Plans in the Southwest Region. * J.D. Power ranked us Highest in Member Satisfaction among Commercial Health Plans in the Southwest Region. * 1 Internal company data * Blue Cross Blue Shield of Arizona received the highest numerical score among commercial health plans in the Southwest region (AZ, NM, NV) in the proprietary J.D. Power 2014 U.S. Member Health Plan Study SM. Study based on 34,315 total member responses, measuring seven plans in the Southwest region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December 2013-January Your experiences may vary. Visit jdpower.com. 10

11 When can you enroll? Open Enrollment November 15, 2014 February 15, 2015 Special Enrollment Period For more information about the Special Enrollment Period visit /SEP Get answers. Get covered. Call Blue Cross Blue Shield of Arizona today hablamos español

12 P.O. Box 13466, Phoenix, AZ D /