Many understand why it is important to enroll in a health insurance plan because it protects them from unexpected medical expenses. However, not everyone knows exactly how these complex plans work or how to compare their current plan with other options.
Splitting the concept of health insurance plans into three categories (enrollment, benefits, and costs) will give you a complete understanding of what it covers, what it costs, and how you can change your plan if it doesn’t fit your needs.
How Does Enrollment Work?
You can adjust, cancel, or find a new health insurance plan through the Health Insurance Marketplace during the annual Open Enrollment Period. The yearly window in most states typically runs from November 1 to December or January 15. If you have a job-based health insurance plan, your employer sets the enrollment period.
If you miss the yearly Open Enrollment Period, you may qualify for a Special Enrollment Period. You can qualify for a Special Enrollment Period if you recently experienced a significant life-changing event, such as losing job-based coverage, moving, or having a baby.
Benefits
There are many types of plans on the Health Insurance Marketplace, each with different coverage, rules, and benefits. However, every plan on the Marketplace will cover ten essential health benefits, including:
- Ambulatory services
- Emergency services
- Hospitalization
- Comprehensive care before and after birth for both the mother and child
- Mental health and substance use disorder services
- Prescription medication
- Rehabilitation therapy
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Marketplace plans will also cover birth control and breastfeeding, with some offering dental and vision coverage. Most plans do not cover alternative medicine, elective surgeries (cosmetic, weight-loss, etc.), unapproved medical care, or experimental treatments or procedures.
Estimating A Plan’s Total Yearly Costs
When comparing plans, evaluate the estimated total yearly costs instead of just using the premium. Several factors contribute to your plan’s total yearly costs:
- Monthly premium: The monthly amount you must pay to have health insurance.
- Deductibles: The amount you spend on covered health services and prescription drugs before your plan starts paying, e.g., you pay for an office visit, but your plan covers the preventive services that come with that visit.
- Copayments, also known as copays: The fixed amount you pay for medical expenses.
- Coinsurance: The percentage of costs you pay for medical expenses.
- Out-of-pocket maximum: The most you have to pay for covered services in a year before the insurance company starts paying.
Some additional cost considerations are that most comprehensive plans will have higher premiums but lower costs. In other words, if you don’t expect needing healthcare services, you could choose a plan with a low premium and high deductible.
To get a more accurate estimate of your total yearly costs for different plans based on the level of care you anticipate for your household each year, visit https://www.healthcare.gov/see-plans/#/.
Better Understand Your Health Insurance Plan Options
When it comes to health insurance plans, understanding enrollment, benefits, and costs is essential and will serve you well throughout your life.
