Nearly 58% of Americans receive health insurance from employers, who pay a portion of the costs. Those lucky 58% don’t have to worry about finding healthcare.
But for the self-employed, independent contractors and the unemployed, finding affordable health insurance can be a battle…an expensive battle.
Finding affordable health insurance for your family is possible, but it’s not easy. That’s why we’ve put together this step-by-step guide to help to help you navigate the maze of the US healthcare system.
Step 1: Know Your Terms
It isn’t just the prices that are confusing in the healthcare world. Health insurance involves all types of words that may be unfamiliar. Before we start finding health insurance, there’s a few terms you should know.
Your premium is the monthly or yearly charge you must pay to keep your health insurance.
Your deductible is the amount you pay before your insurer starts paying. For example, if your policy has a $1,000 deductible, you will need to pay $1,000 until your health insurance kicks in.
Coinsurance is the percentage of your medical costs that you pay. For example, if you have 30% in coinsurance, the insurer pays the remaining 70% of your healthcare costs.
Your copay is the amount you pay for healthcare services at the time of treatment. If your policy has a $30 copay, you would pay that amount on the day of the visit. Policies have different copays for primary care, prescriptions and emergency room care.
This is the maximum amount you will have to pay for health services in a given year. For a policy with a out-of-pocket maximum is $10,000, any healthcare costs above that amount are paid by your insurer.
Step 2: Explore the Marketplace
Under the Affordable Care Act, the federal government designed a database of all available healthcare plans across the country at Healthcare.gov.
The site first asks for your zip code, then directs you to a full list of insurers and plans in your area. Healthcare.gov will also check to see if you qualify for Medicaid or CHIP funding. Next you’ll need to register some personal information to set up an account.
If you find Healthcare.gov confusing to use, you can also use the Policygenius site or app. Policygenius lays out each plan in a more organized way, making it easier to compare and choose the plan that’s right for you.
Step 3: See If You Qualify for Assistance
After creating an account, you’ll be shown a list of available healthcare plans in your area. Each plan displays premiums, out-of-pocket costs, copay, deductible and coinsurance.
The site will also tell you how much you qualify in government subsidies, which lowers your costs. The lower your income, the more subsidies you’ll receive. If your family’s income is below 133% of the poverty line, you could also qualify for Medicare.
Some people will want to pick the plan with the lowest premium, but this is often not your best route. Plans with low premiums often come with high deductibles. Remember that you have to pay the full deductible before the insurer begins paying. Your best bit bet is to find the best balance of premium to deductible so you’re paying less out of pocket.
There are four types of healthcare plans: Health Management Organizations (HMO), Preferred Provider Organizations (PPO), Exclusive Provider Organizations (EPO) and Point of Sale (POS). Each type differs in out-of-pocket expenses and choices of doctors. If a plan is in-network, you’ll have to choose a doctor from your insurer’s network. Out-of-network plans allow you to choose any doctor you want.
5. Make a Choice
Now that you understand the different types of plans and their specific benefits, it’s time to make a choice.
First, think of your family’s medical history. How often do you use medical services? Does a member of your family have a condition that requires a lot of medical care? These questions will help guide you to your choice.
If your family needs frequent medical care, has a surgery planned or if you have a baby on the way, you’ll want to go for a plan that pays a higher percentage of the costs. These plans also tend to have higher monthly premiums, but they pay off in the end.
On the other hand, if your family is in good health and doesn’t need to visit the doctor often, then a lower-premium plan might work better. Keep in mind that you’ll pay higher out-of-pocket costs with these plans.
Getting health insurance is one of the most important decisions we make as adults. With 530,000 American families experiencing bankruptcy from medical costs each year, the stakes are high.
Hopefully this guide will help you find the health coverage you need. Be safe and stay covered.