Health care is expensive. In the past, people without health insurance often waited until they were seriously ill before seeking care, which resulted in larger bills to fight more complex cases. Now, with the advent of health care reform and the Affordable Care Act, things are even more confusing. To make sure you and your loved ones have the best insurance at the lowest cost, take note of the following important details about health insurance.
Health insurance is important to your family’s well-being now and in the future. Unlike other forms of insurance that you purchase hoping to never use (i.e., auto and fire), health insurance is an important purchase that you need to take advantage of regularly for preventive care and tests, and for dealing with any illness before it gets too serious.
Health Insurance Plans in Dallas/Ft. Worth. What are my options?
Individual Texas health insurance is usually described as either indemnity (fee-for-service) plans or managed care plans. These types of plans differ in important ways that are described below. With any health insurance plan, however, there is a basic premium, which is how much you pay, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by plan. In considering any plan, you should try to figure out its total cost to you based on how you use your benefits.
Besides the plans available through the marketplace or on the open insurance market, there are other health insurance options you may be eligible for or may want to consider:
- Medicare is a government health insurance plan for people 65 or older. (Younger people who have certain disabilities or those with end-stage renal disease may also qualify.) Medicare is not sold through the Health Insurance Marketplace; there is a separate government Web site for Medicare enrollment (www.myMedicare.gov). Medicare health insurance helps pay for hospital care, skilled nursing facilities and hospice care. Coverage has been expanded to include preventive care and drug coverage.
- Medicaid provides health care for low-income children and families, as well as people with disabilities. Specific details vary by state.
- The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows people to temporarily keep their health insurance after leaving their job. However, it is costly. Your former employer no longer pays any of your insurance costs, which means the cost is usually much higher than what you were paying before leaving your job. People on COBRA generally pay the entire monthly premium by themselves, plus a monthly administrative fee. Consequently, purchasing new coverage on the marketplace will probably be more affordable.
- The Children’s Health Insurance Program (CHIP) provides inexpensive or free health coverage for low-income children. Exact benefits vary by state.
- Short Term Health Plans are health plans available through the public marketplace that someone buys for a limited period of time. They can be indemnity, HMOs or PPOs. People typically buy Short Term Health Plans while they wait for other coverage to kick in (from a new employer or college, from Medicare, from seasonal employment, and so on). Purchasing a policy for a short timeframe is generally cheaper than going on COBRA.
Questions to Ask
When evaluating plan options, there are several questions to ask to determine how you’ll access care within the plan and what your share of the cost may be:
- Are there limits on which doctors, hospitals, clinics, and/or pharmacies I can use?
- What types of coverage are available for special conditions such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or care in a nursing home?
- Will the plan cover prescriptions my physician might request, and at what levels for generic and brand-name?
- What are the plan deductibles per individual and/or per family?
- What are the co-payments?
- What coverage is there for out-of-network providers?
- What is the most I will have to pay, the out-of-pocket maximum?
- If there is a bill or service I dispute, how is it handled?
- Are there limits on annual visits for certain coverages like behavior/mental health or physical therapy? What is the cost for an emergency room visit?
- Are non-medical specialists such as eye doctors and dentists covered?
- What coverage is there outside of the state or country?
These answers will help you better understand your options and take advantage of the plan you select. To find a health insurance plan that is right for you, contact us today or or call 877.749.2241 to speak to a Custom Health Plan Specialist.