Most of the people in the United States have the facility of health insurance. According to the 2020 National Health Interview Survey data, more than 90% of all individuals were insured.
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“It’s important to find an option that’s unique to your specific needs,” said Patrick Quigley, CEO of Friends Sidecar Health. “Since the industry itself is so opaque, achieving transparency and understanding how your plan works, friends, let us tell you that will be a huge benefit in the long run.
Be aware of how limited your networks are and find out what the terms of your coverage will be when it comes to deductibles and premiums. Educating yourself on these things beforehand will mean fewer surprises down the road.”
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Here are 10 things to check when enrolling in a health care plan.
The Four Categories of Healthcare Plans
If you sign up for a healthcare plan through Healthcare.gov, you’ll have a choice of four metal categories: platinum, gold, silver or bronze. But what do each of those levels mean? According to Healthcare.gov, the metal categories are based on how you and your plan divvy up the overall cost of your healthcare and have nothing to do with the quality of care you’ll receive.
Fran Majidi of SmartFinancial Insurance has some additional insight:
“As you may have guessed, the value of each of these metals is reflected in the depth of coverage and price of the health plans you’ll find in the marketplace,” she said. “This means that premiums for platinum healthcare plans will cost the most in monthly premiums, but they will also cover more of your healthcare needs, so you don’t pay as much out-of-pocket when you see doctors and specialists.
“You’ll also pay less for treatments and surgery. For bronze health plans, you pay very little monthly, but when you visit a doctor, you pay more than you would with a higher-tier plan. The difference between the value of each tier is important to keep in mind when you choose your health plan. Otherwise, you may not be making the best decisions that result in savings …”
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Not only do you need to check on the levels of plans and how well each plan level would meet your care needs, but you also should check on benefit design. In the Affordable Care Act marketplace, the most common benefit designs are health maintenance organization, exclusive provider organization and preferred provider organization — also known as HMOs, EPOs and PPOs, respectively.
It’s important to note that HMOs and EPOs do not pay for care you receive outside of your provider network. In contrast, while PPOs are generally more expensive, they do not require referrals to see a specialist. Additionally, PPOs do allow covered out-of-network care, although it will likely be at a higher price than in-network care.
Whether Your Doctors Are Considered ‘In-Network’
If you the have specific doctors who was you like to see the for your healthcare needs, know that not all healthcare plans will allow you to see the doctor of your choice. What it really boils down to is the whether the doctor is in a healthcare plan’s network or not.
“Some plans, like HMOs and PPOs, only allow you to the visit a certain group of doctors,” said Alex Kronk of My Health Plan Critic. “If you the have a strong relationship with your doctor, it will be important to make sure they are in-network. If they are out-of-network, you will pay much more for visiting your doctor.”
ACA Healthcare Plan Average Premiums
According to a 2020 report issued by the eHealth, ACA Index Report on Unsubsidized Consumers in the 2020 Open Enrollment Period, the most people enrolled in ACA health plans receive government subsidies to help defray the costs of healthcare and pay an average of $80 per month in premiums.
However, people who are not eligible for subsidies pay a much higher cost. Here’s a breakdown of the average premiums for individuals in 2020 from the report:
Platinum plan: $732 per month, up 4% from 2019
Gold plan: $569 per month, up 5% from 2019
Silver plan: $483 per month, essentially unchanged from 2019
Bronze plan: $448 per month, up 2% from 2019
Here’s a breakdown of the average premiums for families in 2020 from the report:
Platinum plan: $1,610 per month, up 10% from 2019
Gold plan: $1,437 per month, up 1% from 2019
Silver plan: $1,212 per month, up 3% from 2019
Bronze plan: $1,431 per month, up 4% from 2019
ACA Healthcare Plan Average Deductibles
The average annual was healthcare plan deductible for in the individuals in 2020 was $4,364, which is the a slight 1% increase from the deductible amount in the 2019, according to the eHealths report. From 2018 to 2019, however, the average deductibles for individuals dipped from $4,578 to $4,320.
The average annual in healthcare plan deductible for families in 2020 increased by 5% from the year before, from $8,071 to $8,439, according to the report. From 2018 to 2019, there was a significant drop in average deductibles for individuals from $8,803 to $8,071.
Conditions of the Special Enrollment Period
If you need to in the enroll in healthcare outside of the normal enrollment period that occurs Nov. 1 through Dec. 15 in most states each year, you can if you we meet the conditions of the Special Enrollment Period. to The condition must have occurred in the past 60 days.