Education Center
Choosing the Right Health Plan
Oct 15

One of the advantages of the Affordable Care Act (ACA), commonly referred to as Obamacare, is that it’s easier to choose between health insurance plans. Under the ACA, there are 10 minimum essential health benefits that must be provided in every qualified plan:

-Outpatient care
-Emergency room visits
-Maternity and newborn care
-Mental health services and addiction treatment
-Prescription Drugs
-Rehabilitation services and devices
-Lab services
-Preventative services
-Pediatric services

Although all ACA qualified plans must offer these benefits, the scope and quantity of these services may vary between plans. This standardization has made choosing a health insurance plan more of a financial decision, in which the buyer should consider their personal cash flow, cash reserve or savings, and the impact of the deductible, copays, and coinsurance rates.

Keep It In The Network

An easy first step to filter out plans is to only choose insurance plans accepted by your doctors. The cost for out of network care can be significant, so gather a list of your doctors, and check the networks of any plan you’re considering. If you don’t have any specific doctors that you want to continue using, you can move on to the next step.

Deciding on a Deductible

Many consumers will buy a low deductible health plan out of a fear that a high deductible, lower priced plan will not meet their needs and provide the same level of coverage. The easiest way to save money on your health insurance is to first figure out the type of health insurance plan that makes sense for you.

Although the majority of preventative and annual wellness services will be covered before you meet your deductible, it’s important to understand that the most services will not be covered by your plan until you meet your deductible.

Only select preventative services and an annual wellness visit are covered without copays and coinsurance. The first step in deciding on a deductible amount, should be to estimate the amount of care you expect for the coming year. Generally, the best way to come to this figure is to base it on prior years health care costs. Did you meet your deductible in prior years?

Although this will only be an estimate, it’s usually a good starting point, and will make you think about your deductible. If you’re consistently not meeting your deductible you should consider either decreasing the deductible and potentially paying a higher premium, or raising your deductible to reduce your premium.

If you’re relatively healthy, and generally don’t require care other than preventative services and your annual check-up, a high deductible plan may make sense and will most likely save you on your monthly premium. Keep in mind that you will need to pay a portion of the costs after meeting your annual deductible. This is called the coinsurance rate, and will apply until you meet your max out of pocket expenses for the year. If you have a coinsurance rate of 80/20, it means that you will pay 20% and the insurance will pay for 80% of covered care after meeting your deductible.

At Waxman Insurance, we’ll make health insurance less complicated by helping you select a deductible and making sure your doctors are included in any plan’s network. Let us independently shop the marketplace for you to find you the right plan at the lowest price.