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Understand and Compare Health Insurance Plans
Health insurance offers financial protection for you and your family in case of an accident or illness. It also helps pay for medical costs and unexpected hospital or doctor bills.
A health insurance plan features preventive care, such as annual check-ups and screening tests, often at no cost to you. Comparing health insurance plan options can be confusing, especially if you’ve never purchased health insurance before. Our guides help you determine the best insurance options for your needs, while our tools help you compare and save.
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Health Insurance By State
Health Insurance buyer's guide
Everyone needs health insurance if they live in the United States. Healthcare costs are only rising, and health insurance helps make paying for medical services more manageable. Some states require individuals to have health insurance or pay a tax penalty.
An individual health insurance plan will cover only you and your healthcare costs. This is a good option if your employer doesn’t offer healthcare or if you aren’t eligible for health benefits. You can purchase an individual policy from the marketplace, an insurance agency, or through an agent.
For coverage of two or more people, a family plan is best. Family plans apply to you, your spouse, and your children. Instead of individual deductibles, you will have one family deductible.
Married Couples Without Kids
Couples without children still need healthcare and can benefit from a family plan. Healthcare costs can double when you’re married. A health insurance plan helps manage those costs.
Pregnancy and childbirth come with plenty of unexpected expenses. Many private health insurers help women and their families by covering prenatal care and screenings.
Self-Employed Individuals and Families
Anyone self-employed can benefit from a health insurance plan, especially since they don’t have an employer-provided plan. Self-employed individuals and their families are eligible for care through the marketplace. Many private insurers also offer healthcare plans for the self-employed.
The Affordable Care Act (ACA) allows young adults under age 26 to stay on a parent’s health insurance plan. Students may want to buy a student health plan to maximize their access to healthcare, especially if they attend college in a different state. Many colleges require students have health insurance before attending class.
Low-Income Individuals and Families
Coverage for low-income individuals and families helps ensure they receive care for disease and illness. Instead of visiting the emergency room for care, they can see a family doctor or specialist as needed.
Key Factors In Health Insurance Plans
As you explore your options and compare health insurance rates, here are a few key terms you need to know. These terms may sound confusing, but we’re here to help.
Each health insurance plan features a premium. This is the amount you’ll pay for your insurance policy. It’s based on the type of plan and coverage you select.
A deductible is an amount you must pay before your insurance covers your medical bills. The deductible varies based on your plan.
Typically, the lower your deductible, the higher your premium. So if you are worried about monthly costs and don’t have a lot of medical expenses, you might look for a high-deductible health plan
An out-of-pocket expense is any expense that isn’t covered or reimbursed by your insurance.
You have a copay or a fixed amount you pay for covered medical services after you meet your deductible. The copay is set according to your insurance plan.
Once you meet your deductible, your insurance will pay a certain percentage called coinsurance. It applies to office visits, tests, hospital stays, and other listed medical services in your plan.
HSAs and FSAs
Health savings accounts (HSAs) and flexible spending accounts (FSAs) are tax-free bank accounts used to pay for out-of-pocket medical expenses.
While these accounts have similar purposes, there are several differences between an HSA and an FSA account. For example, an HSA is only available to people with high-deductible health plans.
Comparing Health Insurance Metal Tier Plans
State health insurance exchange plans are available in levels or metal tiers. These tiers are Bronze, Silver, Gold, and Platinum. Each tier has an associated deductible, out-of-pocket maximum, and premium. Catastrophic plans may be available in some areas depending on your age, your location, and whether you have pre-existing conditions.
A Bronze health insurance plan has the lowest monthly premium but higher deductibles and expensive medical care. This tier is good if you don’t have major medical conditions and want protection if you’re seriously sick or injured.
Silver plans are more moderate than Bronze and typically have a lower deductible. You won’t pay high care costs and it’s a good plan for routine care.
A Gold plan has a low deductible but a high monthly premium. You will have low-cost care, which is ideal if you regularly seek treatment.
Platinum plans have the highest premiums and the lowest care costs. They have very low deductibles compared to the other tiers.
A Catastrophic health insurance plan helps in case of an emergency illness or accident. These plans vary in preventative care and options and have high deductibles.
- Every health insurance network type differs. Some will offer a greater range of services, while others will restrict you to certain providers. Let’s break down the various types of plan provider networks.
- Health Maintenance Organization (HMO) — HMOs are networks of providers. As an HMO member, your insurance company will pay for your health care only when you visit providers within the network.
- Preferred Provider Organization (PPO) — PPOs mean you pay less for medical providers such as hospitals, doctors, and other medical providers within the network. Providers outside your network will have an additional fee.
- Exclusive Provider Organization (EPO) — EPO plans only cover services when you use members in the network for care unless you have an emergency.
- Point Of Service (POS) — POS plans let you pay less when you use healthcare providers within the network. When you want to visit a specialist, however, you must obtain a referral from a primary care doctor.
- Private insurance — Private insurance is any health insurance plan you purchase from a private company and not from a state or federal-run marketplace. Employer-provided plans are an example of private insurance.
- Short-term insurance — If you’re without employer-based insurance coverage temporarily, short-term insurance bridges the gap. Short-term insurance is good if you’re between jobs, self-employed, or need healthcare for traveling. You purchase short-term insurance directly from a private company, not through the government. A short-term plan lasts 12 months or less. You may be able to extend your plan, however, this varies by company. Your coverage in a short-term insurance plan is typically active within 24 hours of enrollment.
- Supplemental health insurance products address additional care that might not be covered under a regular health insurance plan.
- Dental Insurance — Dental insurance is any care related to your teeth. It often covers routine and preventative care when you see the dentist. Like with health insurance plans, you pay less when you visit in-network providers. Annual cleanings, fillings, and other non-cosmetic treatments are often covered.
- Vision Insurance — Vision insurance is insurance specifically for eye health. This type of plan covers routine eye care such as eye exams, glasses, and contact lenses.
- Gap Insurance — Gap health insurance is a supplemental group health insurance plan. If you have high care costs, gap insurance can help if you haven’t met your deductible, or if you’re between jobs and waiting for your employer’s insurance to start.
- Critical Illness Insurance — If you have a medical emergency, such as a stroke, cancer, or heart attack, you’ll have high medical costs. Critical illness insurance is meant to address these financial concerns by paying a lump sum for costs your health insurance plan doesn’t cover. You might also use the payment for costs related to medical care, such as transportation.
When To Buy Health Insurance
If you want to buy health insurance, you must wait until the open enrollment period, or the time when anyone can shop for health plans on the exchange. Private insurance companies don’t have enrollment periods, so you may choose to buy their plans at any time.
Open Enrollment Period (2023)
The open enrollment period for 2023 ended on January 1, 2023. Enrollment for 2024 begins starting November 1.
Special Enrollment Period
You may be eligible for a special enrollment period if you had a life change within the past 60 days. These changes are known as “qualifying life events” and include:
- Giving birth or adopting a child
- Getting married
- Moving to the U.S.
- Moving to a new state, new zip code, or county
- Moving to or from school
- Divorce or separation which results in loss of health insurance
- Death of a policyholder
- Relocating to a shelter or transitional housing
- If you or any household member lost healthcare coverage in the past 60 days or longer than 60 days but before January 2020
You may be asked to provide documentation of these life changes when completing your application.
FAQs For Health Insurance Plans
What do on-exchange and off-exchange mean?
On-exchange means health insurance plans purchased through the federal or state health insurance portal. An off-exchange plan is a policy offered outside of the marketplace. These plans are purchased directly from a provider or through an agent or broker.
If I have health insurance through my employer do I need to purchase an additional plan?
If you have health insurance through your employer, you may choose to purchase another plan, but you aren’t required to.
Can you buy health insurance at any time of the year?
You can buy health insurance from a private company throughout the year. You may only buy health insurance through the exchange during open enrollment or any time of the year if you qualify for a special enrollment period.
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