HOW TO PICK A HEALTH INSURANCE PLAN

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Plan and Network Types

There are various plan and network types from which to choose. Some plan types allow you to use almost any doctor or health care facility, while others limit your choices or charge you more if you use providers outside their network.

Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

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Total costs

You pay a monthly bill to your insurance company, known as a premium, as you would for any insurance you have. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.

Deductible: How much you have to spend for covered health services before your insurance company pays anything (except free preventive services)

Copayments and coinsurance: Payments you make each time you get a medical service after reaching your deductible

Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

When you compare plans in the Marketplace, the plans appear in 4 “metal” categories: Bronze, Silver, Gold, and Platinum. The categories are based on how you and the health plan share the total costs of your care.

Bronze: If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Bronze plan. These plans can have very low monthly premiums, but have high deductibles and pay less of your costs when you need care.

Silver: If you qualify for "cost-sharing reductions": Silver plans may offer good value. If you qualify for extra savings ("cost-sharing reductions") your deductible will be lower and you’ll pay less each time you get care. But you get these cost-sharing reductions ONLY if you enroll in Silver plan. If you don’t qualify for extra savings, compare premiums and out-of-pocket costs of Silver and Gold prices to find the right plan for you.

Gold: If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.

Information obtained from www.healthcare.gov

Next Steps...

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