Three Things to Consider Before Picking an Individual Health Insurance Plan

U.S. residents, who are not covered by the employers, or who are unemployed have the option of Individual health insurance plans, which are specifically designed to cater to the need of such people. Residents can shop for individuals health insurance plans on their state's public marketplace, if available or through the federal marketplace to find the lowest premiums. People also have the option to purchase health insurance through a private exchange or directly from an insurer. Though, by choosing these options they won't be eligible for income-based discounts on their monthly premiums.  

 

Irrespective of their chosen health insurance marketplace, people need to keep these three things in mind while shopping for Individual plans.

 

 

Individual Health Insurance Plans Categories - People shopping for these plans need to know that there are four categories of health plans categorized as Bronze, Silver, Gold, and Platinum. The plan categories do not signify the quality of the healthcare but it depicts the cost-sharing between the insurance carrier and the insured. In the Bronze category health plans, the insurance company pays about 60% of the cost whereas the insured pays 40% of the cost. In the Silver category plan, the insurance company pays 70% of the cost and the insured pays 30% of the cost. In Gold plans the health insurance company pays 80% of the cost whereas the insured pays 20% of the cost and in the Platinum plan the insurance company pays 90% of the cost and the insured pays 10% of the cost. However, the Bronze plan comes with the lowest monthly premium but costs highest when the insured needs healthcare. Silver plans have a moderate monthly premium as well as moderate costs when the insured need medical care. Gold plans have a high monthly premium but low cost when healthcare is required by the insured. Platinum plans have the highest monthly premium but the lowest costs when receiving health care. 

Think not just about the Premium but about the Total Healthcare Costs – While shopping for health insurance plans people often just focus on monthly premiums and tend to ignore other out-of-pocket costs that have a big impact on total health care spending. Besides, monthly or annual premium people also need to pay out-of-pocket expenses like deductibles, out-of-pocket maximums, co-payments, and coinsurance. The deductible is the amount which insured need to spend for covered healthcare services the insurance company pays anything. Co-payments and coinsurance is the amount which insured make every time they receive medical care after reaching their deductible. The out-of-pocket maximum is the maximum amount, which the insured has to spend for covered medical services in a year after which the insurance company pays 100% for the covered services.

Different Types of Individual Plans Available – U.S. health insurance marketplace offers different types of Individual health insurance plans that are designed to meet different needs. Some of the popular types of Individual plans available are HMO, PPO, POS, and High Deductible Health Plan with Health Savings Account. People while comparing for these plans should look for a summary of benefits along with the cost. With HMO plans insured have to stay within the network to obtain coverage and need to have a Primary Care Provider for managing their health and for providing referral before seeing a specialist. HMO plans also have lower out-of-pocket costs. With PPO plans in-network care is less expensive and these plans come with more healthcare provider options and no referrals are required but out-of-pocket costs are higher. With POS plans it is not necessary to stay within the network of healthcare providers but in-network care is less expensive. Members of these plans need to have a primary care provider for managing their health and to provide referral before visiting a specialist. The POS plans to have more provider options. HDHP plans have lower premiums but higher out-of-pocket costs, especially at first.