![]() Premium, Deductible and Out-Of-Pocket Costs. Ensuring that a plan includes the minimum essential health benefits provides a safeguard. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. All exchange plans must cover 10 essential health benefits. ![]() However, if your health status requires a good deal of care, then perhaps a gold or platinum plan, which costs more, will actually cost you less in the long run.Īre Essential Health Benefits Covered? – One way of ensuring the plan you purchase or intend to purchase covers the 10 essential health benefits, is to buy an on-exchange plan. For example, if you find that you have minimal health insurance needs then perhaps a bronze plan would best suit you. Based on your medical needs you should be able to relatively compare an appropriate metal level. Silver is set at 70%, Gold 80%, and the most valuable metal platinum is set at 90%. In theory, a bronze plan will cover 60% of your medical costs and provide you with a maximum out of pocket dollar amount that does not equal the remaining 40% but instead is a threshold set for most bronze plans. Bronze, silver, gold, and platinum all represent the metal worth and the level of coverage offered under each metal plan. These insurance levels are grouped into 4 metals based on actual metal value. Metal Levels – In order to make shopping and comparing health plans easier, a metal system to represent different insurance coverage levels was created. The last two types, HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs For a better understanding of these types of coverage please refer to the following article. If you find that you travel often for work or live in multiple states per year, then perhaps a plan that offers that flexibility is needed. If you’re often seeing specialists out-of-network then you want a plan that offers that flexibility. Also, different plans have different requirements related to the need for referrals. The first 4 are acronyms that describe different types of health insurance coverage, which provide you with or without the flexibility to see specialists and receive out-of-network and out-of-state care. Types of Insurance Coverage – EPO, PPO, POS, HMO, HDHP and HSA. As such, be sure to choose the right plan that suits your needs before signing the contract. Additionally, if you buy an individual health plan on your state exchange or through and you allow that plan to lapse or you stop coverage, then you don’t qualify to buy a health plan on that exchange for the rest of that calendar year. You’ll have to wait for your contract to expire. If you find that you are not happy with your plan, you can’t go back to your insurance company mid-year and ask them to change coverage. Health Insurance is a Contract – When purchasing a plan, both parties agree to live up to the contract (usually for a period of one year). Be sure to consider your current health condition when shopping for a health insurance plan. However, if you find that your medical expenses and prescription usages are high, then you may save money by purchasing a plan that costs more per month. ![]() If you’re someone who happens to be in good health and does not foresee any health-related issues and doesn’t use medicine on a very regular basis, then perhaps you’re better off opting for a lower costing health insurance plan. Lower Monthly Premium May Result in Higher Costs– Health insurance follows a simple formula: the lower your monthly premium is, the more likely you are to pay higher costs when you use the insurance. Why the concern? Well, keep in mind that if an out-of-network provider suggests services, then all of those services provided by that recommended doctor will be considered out of network, even if the facilities and providers are in-network You should always confirm with the insurance company or an agent that your doctors are in-network. Don’t just ask the doctor’s office if they accept a certain insurance plan before you enroll. Going to an out-of-network doctor may cost substantially more than if that doctor is in-network. What to Know When Shopping for Health Insuranceīelow are some of the most commons concerns when shopping for a Farmingdale health insurance plan.Īre Your Doctors In-Network – Before purchasing a health insurance plan you should always make sure that your doctor(s) are part of the network.
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