The health insurance market in the United States it’s really complicated. In fact, there are studies that indicate that most American workers decide on a health plan that ends up being more expensive throughout a year than it really should cost, choosing another alternative.
For this reason it is important that you learn to choose a plan that is cheap for you and meets your needs, but how to do it?
Steps to choose the health insurance market in USA
Follow this step by step to decide the best health insurance market in the United States:
Step 1: First of all, you should talk to your doctor to make sure that he will accept your insurance plan. It is important because by sending a limited group of patients to doctors and hospitals, insurers negotiate discounts, in the same way that a supplier of wholesale merchandise can give discounts to consumers.
If your doctor does not agree with your insurer, you will most likely pay an out-of-network fee and therefore medical care will cost twice as much as in-network doctors.
In fact, when you go out of the doctor’s network, many of the protections under the Affordable Care Act don’t apply. An example of this is preventive care, counseling services, vaccinations, and annual physicals. You get all of these protections if your doctor is among network health care providers.
Step 2To know which is the best insurance plan, you must have an idea about the common costs of health care, for which you should answer some questions such as what your deductible has been the previous year.
What is the deductible
The deductible is an amount of money that you will spend out of your pocket before your insurance pays part of the bill. Once the deductible is reached, you are responsible for paying the coinsurance or copayment and your insurer will collect the rest based on the payment for in-network medical care.
Coinsurance means that you will pay a percentage, usually 18% of the cost of medical care for primary care and another percentage of 19% for a specialty care visit.
With a high deductible, you pay low monthly premiums. If you did not meet your deductible last year, this year you can choose a higher deductible than the previous year and you will save on premiums, but you must save for the full deductible in case someone in your family needs medical attention.
Step 3: Compare the plans by multiplying the premium of each plan by 12, then add the maximum out-of-pocket cost and you will get as a result what you will spend in full in the event that you need medical attention in the current year.
Types of health insurance
Between the types of health insurance there are 4 categories. Although they have different characteristics, they all tell you how costs are shared without having to do with a better or worse quality of medical care.
You must pay a bill every month to your insurance company, which is called a premium and you will have to make this payment even though you do not use medical services.
When you receive medical care, you pay your out-of-pocket costs and your deductible.
The types of plans are: EPO, POS, PPO, and HMO. They differ because with some you can choose the health care center and your doctor while others when choosing the doctor or health care center of your preference will charge you a greater sum of money.
The major health insurance plans are those that adhere to the affordable health care law known as Obamacare.
Obamacare health plan
Obamacare health plans include the qualified health plans that you can buy with a subsidy and include:
- Catastrophic plans aimed at people under 30 years of age.
- Medicare and Medicaid among others that correspond to the coverage of health insurance sponsored by the government.
- Short-term health insurance is a type of health insurance product that does not qualify as primary health insurance.
Under the Affordable Care Act (ACA), all health plans must offer you a type of essential health coverage, which is why a plan cannot deny you during the open enrollment period due to medical reasons and pre-existing conditions.
Even all plans must offer you specific health services and treatments regardless of the insurance company where you buy the plan.
Average monthly premiums
On average, monthly premiums for Obamacare plans without government subsidies are $ 833 for families and $ 321 for an individual plan.
HMO is the most popular type of health insurance plan. It provides you comprehensive, prepaid health care services. You must choose a primary care physician and location from among those in the HMO provider network.
The primary care physician is the one who manages health care treatment and requests referrals for specialty services.
They generally have a common basic benefit plan but some may provide you with other benefits or not include coverage for some providers, such as chiropractors.
All of them have a limited policy maximum.The copays and deductibles, regarding the prescription drugs you pay, are applied to your maximum out-of-pocket, so when you reach the maximum out of pocket, health expenses, medical expenses and Prescription drug expenses are covered 100% for the rest of the year.
The PPO plan is the one your employer can offer you. With this plan you can visit doctors in the network and outside of it. However they will charge you high premiums.
The PPO is also offered by a private health insurance company. You’ll pay less when you choose hospitals, doctors, and healthcare providers that are in the plan’s network, and you’ll pay more if you choose out-of-network providers, hospitals, and doctors.
You can receive medical care from another healthcare provider, any doctor or hospital, but it is your decision to pay more for it.
Well, you have the flexibility to choose what you want, but it will be cheaper if you choose a provider within the network.
EPO gives you the flexibility to choose your primary care doctor, but within a limited network of hospitals and doctors and you will not have coverage outside the network unless it is an emergency.
In this way, if you go to a hospital or doctor that does not accept your plan, you will have to pay the costs.
In short, if you prefer coordinated medical care through only one doctor, you should choose the HMO plan, but if you are looking for greater flexibility or if you go to many specialists, you may need a PPO plan and you should choose the EPO plan, if you want to save money using a small network of doctors and hospitals.
USA health insurance
With no NHA in America, the government proposes funding health plans like Medicare and Madicaid for the young, poor, beheaded, and old.
But in the job package, most employers include paid health care, however the problem arises if you lose your job.