Tips for Finding an Affordable Health Insurance Plan

Finding affordable health insurance can be a major challenge. Whether someone is in between jobs, self-employed or just needs independent coverage, he or she may be overwhelmed by the options. Health care is an incredibly complicated subject, and surveys of the American population indicate that most people struggle to understand how it works. In fact, many Americans feel that they have trouble choosing the best health care plan for themselves and their households.

Understanding what your health care options are can help you figure out how to choose the best and most affordable health care plan for you. You may be tempted to sign up for the cheapest health care plan around, but that can come with numerous limitations and provide insufficient coverage. Instead of looking for the lowest cost you can find, you can learn how to compare coverage to get the best value.

Find Out What You May Qualify For

One of the first steps to take in the search for affordable health insurance is to figure out if someone in the household qualifies for any special programs or subsidies. For example, the Children’s Health Insurance Program provides low cost or free health care to children younger than 19 years of age. To qualify, children must live in a household whose income is around 150 percent of the Federal Poverty Level (FPL) or lower.

You may qualify for low cost or free health care through the Medicare program. If you are 65 years of age or older or receiving Social Security Disability Insurance (SSDI) for more than 24 months, you are eligible for this program. If you have certain medical conditions, such as Amyotrophic Lateral Sclerosis or kidney failure, you may receive Medicare the first month that you receive SSDI. You can visit the Medicare website to determine if you are eligible for coverage.

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TIP BOX

Make sure to explore all your health care options before signing up your family for all plans. Some plans may not meet everyone’s needs, depending on the level of care they need.
Make sure to explore all your health care options before signing up your family for all plans. Some plans may not meet everyone’s needs, depending on the level of care they need.

Another program for affordable health insurance is Medicaid, which is aimed at low-income Americans. Medicaid eligibility is based on family size and income, but the income requirements vary by state. Some states have chosen to expand Medicaid eligibility for people whose income falls below 138 percent of the FPL. States that did not expand may have left the Medicaid eligibility level as low as 50 percent of the FPL. Those that did not expand have left a coverage gap, which may mean you are not eligible for Medicaid or federal marketplace subsidies. You may be eligible for subsidy assistance if your income is between 100 and 400 percent of the FPL.

Under the rules of the Affordable Care Act, also called Obamacare, you can remain on your parents’ health care plan until you are 26 years of age. On your 26th birthday, you will be dropped from your parents’ plan and obligated to seek your own. If you aged out of the foster system, you can remain on Medicaid until you turn 26, unless you qualify based on income.

Learn About Coverage Through Medicaid Services

If you meet the Medicaid eligibility requirements and sign up for coverage, you can receive free or affordable health care coverage. Nevertheless, what benefits you receive exactly can vary from state to state. The federal government has made some benefits mandatory for states. Other benefits, however, are optional. The mandatory benefits include the following:

  • Inpatient/outpatient hospital services
  • Early and periodic screening, diagnostic and treatment services
  • Family planning/nursing facility/nurse midwife services
  • Birth center services, when licensed
  • Tobacco cessation counseling for pregnant women
  • Pediatric and family nurse practitioner services
  • Physician services
  • Nursing facility/home health services
  • Rural health clinic/federally qualified health center services
  • Lab and X-ray services
  • Transportation to medical care

These Medicaid benefits are mandatory across states. This means if you are enrolled in Medicaid, you will receive these basic benefits determined by the federal government. However, some states may cover additional services that others do not. Those services include, but are not limited to, the following:

  • Prescription drug coverage
  • Physical or occupational therapy
  • Speech, hearing and language treatment
  • Podiatry services
  • Dental or vision coverage
  • Hospice care
  • Chiropractic services
  • Inpatient psychiatric services under 21 years of age

States are not required to provide the coverage listed above, which means your Medicaid benefits may or may not include them. Your coverage may include some of the optional services, most of the optional services or none of them. To find out what coverage is provided in your state, visit your state’s Medicaid website.

How to Find & Compare Plans

Employer-provided insurance is typically going to be the most affordable health care option for you. If you have employer-provided coverage, this option should probably be your first choice. However, if you do not have employer-provided affordable health insurance, you can look on the Health Care Marketplace at the Marketplace website. This option is typically only available during the enrollment period at the end of the year. However, you may qualify for a Special Enrollment Period after a major life event like marriage or a job change.

If you cannot find a satisfactory plan on the Marketplace, you can search for affordable health care outside the system. You can use the website’s Plan Finder feature to locate additional private health care plans. However, you can receive subsidies and tax credits from Marketplace plans – you cannot do so with private plans. Therefore, private plans are typically more expensive and less affordable.

Browse the health care marketplace, your employer’s options or private coverage to see what plans are available at what price points. What kind of plan you need depends on both your budget and your personal health assessment. To pick the best coverage, begin by figuring out what type of plan you want:

  • An HMO (health maintenance organization) plan requires referrals to visit specialists, but provides lower out-of-pocket expenses. Your primary care doctor has more control, since he or she must issue referrals. You must remain in network for coverage, except in cases of emergency.
  • A PPO (preferred provider organization) provides cheaper in-network coverage, but offers more flexibility. You do not need a referral for specialists, ultimately granting you more options for providers.
  • An EPO (exclusive provider organization) requires you to stay in-network, but does not require referrals. It is cheaper than a PPO without the focus on your primary care doctor.
  • A POS (point-of-service) plan requires you to stay in-network unless you have a referral. However, it includes more comprehensive care from your primary doctor and more provider options than an EPO or HMO.

If your priority is affordable health care, you should select a plan that minimizes expenses. However, if you want to keep a current doctor or maintain a wide and flexible network of options, you may want to select a PPO, EPO or POS. Examine the out-of-pocket expenses, such as copayments and deductibles, for each plan. Compare the included benefits to see if a plan provides the coverage that you need. For example, some plans may include mental health services while others do not. Make sure that you review what medications you take, what health issues you have or run in your family and what risks you face.

Remember, it is not advisable to simply select a cheap medical insurance plan because of its price. You should carefully review the benefits of a plan before selecting it, particularly private plans. It is important to confirm that a particular plan includes the coverage you require. Additionally, consider the cost of seeking treatment. Will a particular plan allow you to seek affordable treatment, or will you have a high deduction that exceeds your typical medical bills? It is important to select affordable health insurance that is right for you and your medical needs.



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