By: Ian Marable
There have been many changes to the insurance arrangement under the Affordable Care Act. Whether you’ve been unaffected by the changes, have been forced to select a new insurance plan as a result of the ACA, or are among the 15 million remaining uninsured individuals, currently looking for insurance, this guide is designed to help you with the basic steps towards getting the right plan for you.
If you were previously insured before the ACA and are satisfied with your coverage and the price of your premium, you may not have to do anything in regards to getting new insurance. Many plans were “grandfathered” in under the ACA, meaning as long as the changes did not significantly violate any ACA provisions, the policy stays intact. All plans that were grandfathered in must disclose that they were, so there’s no secret of whether not your policy was grandfathered in. If, on the other hand, you wish to cancel your previous plan to seek a new one https://www.healthcare.gov/reporting-changes/cancel-plan/ has a handy guide to help you do just that.
However, if you don’t have a current plan or are looking for a new one, the first step is to check whether you and your family qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or subsidies to help you pay for your insurance.
Under the ACA, Medicaid was expanded to 133% of the federal poverty level (currently up to about $30,000 for a family of four). Although Medicaid coverage varies by state, in each state you will be covered for most: ambulatory services, visits to doctors, urgent care clinics, hospitalization, maternity, newborn care, family planning, and pediatric services. And while, a downside to Medicaid is that many doctors decide not to accept it because they get paid less than they get from other insurance plans, it can nonetheless generally provide for most of your medical needs. To see if you qualify for Medicaid or assistance go to https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/#howtoapply.
If your income is too high to qualify for Medicaid, your children may still qualify for the Children’s Health Insurance Program (CHIP) or other related state plans. Coverage includes, among other things, prescriptions, visits to doctors, hospitalization, x-rays, ambulatory services, and dental care. If you’d like to see if your child or children qualify for CHIP choose your state and fill in the information at http://www.insurekidsnow.gov/state/index.html.
Even if you and your family don’t qualify for Medicaid or CHIP, you may still qualify for government subsidies to help pay for coverage. Check https://www.healthcare.gov/lower-costs/ to see if you do.
Coverage and Types of Plans
If you don’t qualify for government assistance and you and your family are not adequately insured by your employer’s health insurance plan, then the two things you need to consider when choosing your health plan are, the amount of coverage and the type of plan that interests you. Many states such as Colorado offer free in-person and online help to help you choose what insurance plan is best for you http://connectforhealthco.com/person-help/. A simple engine search for your state may turn up similar programs too.
In cases where no help is available in your state or if you choose to go at it alone, in general, when considering the amount of coverage, consider: what premium you can afford, how often you and your family go to the doctor, and how much you have to lose. There are four “metal categories,” with concern to coverage: bronze, silver, gold and platinum. If you and your family have a lot to lose and often go to the doctor’s office or hospital, you may want to consider a gold or platinum plan, as copayments will be lower for the many visits, but if you can’t pay as high of a premium or you and your family don’t go to the doctor’s office as much, you may want to consider a different plan. For more information about the metal categories and amount of coverage, visit https://www.healthcare.gov/choose-a-plan/plans-categories/.
Types of Plans
Types of plans too differ depending on you and your family’s specific needs. Among these plans are Health Maintenance Organizations, Exclusive Provider Organizations, Point of Service plans, and Preferred Provider Organizations. While EPOs and HMOs are generally cheaper, consumers are usually confined to providers exclusively within their network, which may create difficulties if you want to see a different doctor for a medical issue or a specialist in another area, outside the network. PPOs and POS plans, on the other hand, while more expensive, generally provide at least some coverage for doctors and medical treatment outside the network. As with anything, you’ll have to weigh the costs and benefits for your family in choosing the right type of plan. For more information on types of plans visit: https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf.
Each individual’s needs is different and it’s important to consider all information relevant to you and your family’s needs when deciding on your plan, and of course seek help when necessary.