Compare Health Insurance
With the rising costs of health care, health insurance has become a necessity. Add to it the fact that the Affordable Care Act has now made the insurance available within the grasps of the people as well as mandatory; thus choosing a health care is of utmost importance right now.
Minimum Essential Coverage (MEC)
Minimum Essential Coverage is a set of plans, including those available at government exchange, those provided to employees and most of the open market plans. With the implementation of the Affordable Care Act, it is now mandatory for every individual to have an insurance cover or else a fee is bound to be levied on them. An exception of three months is allowed in a year and a few special categories are exempted.
Health Insurance Marketplace or Private Insurance Plans
With the implementation of the Affordable Care Act, there is either a Health Insurance Marketplace at state level or there is a common exchange maintained by the federal government to serve people for the purchase of insurance. There is also the option of buying insurance privately from open market. Buying insurance from one or the other can come down to a few basic factors to help compare health insurance.
What you get with the government exchange:
- Subsidy and Cost Assistance: Only plans purchased at marketplace are eligible for cost assistance. If a person’s income ranges between 100 to 400 percent of national poverty level (133 percent in a few states), they are eligible for cost assistance and tax credit on insurance. Only silver plans qualify for cost subsidies.
- Multiple insurance plan options at a single place allow for easy comparison.
Why to consider the private insurance:
- If individuals do not qualify for cost assistance they can go for open market.
- A government exchange has only a limited set of plans. For a wider range of options, an individual may consider open market.
- Private plans may have a broader network of doctors, hospitals and laboratories.
Types of Insurance Plans:
Health maintenance organizations (HMOs)
In these plans, the cover is limited only to the experts and hospitals inside the HMO’s network. Outside the network, all the bills will have to be covered by the patients themselves. Also, a patient cannot see a specialist unless referred by a physician.
Preferred provider organizations (PPOs)
With these plans, there is more pliability in choosing the expert that a person can visit and to see a specialist, a referral may not be needed. Some amount of the bill, while visiting a doctor outside the network, will be provided by the insuring company; but still the majority will have to be covered by the individual themselves.
Exclusive provider organizations (EPOs)
These plans provide a little more freedom than the HMO’s by granting access to a wider set of health care providers. Also, they are lenient in requirement of a referral while seeing a specialist. However, any service outside the EPO’s network will not be covered by the insurer, except an emergency.
Point-of-service (POS) plans
These plans are a combination of the features of HMO and PPO. These allow extreme flexibility in choosing the health care provider to the patient. A referral is mandatory to see a specialist inside the network. The insurer will cover some part of payment if a patient sees out a network specialist but the major part will be covered by the patient himself.
Factors to consider while choosing Insurance Plans
Consult your doctor
Check with your doctor to see if it is in the network of the plan you are about to enroll in. This will lead to lower medical expenses as compared to out of network doctors where you might have to pay much more. Some services are covered only limited to in-network providers or you might end up paying for the service if you go outside the network.
Identify the health care you might require
Estimate the services that you might employ in the coming year by referring to your medical history of previous years. Consider the number of visits to doctors and referrals to specialists, and the prescriptions. Compare different plans based on the costs you estimated.
Consider the amount you will pay
Check the monthly premium amount that you will have to pay for different plans. Also consider the deductibles. A deductible is a minimum amount that you are required to spend from your own pocket for health care service before the insurance company starts covering it.
Considering all the above factors, an individual may arrive at the health plan that is the most beneficial for them and has the lowest premium for the same set of benefits.