Written by Amanda Menard, LPN
A Guide to Understanding Your Coverage, Costs, and Quality of Care
The health insurance landscape has changed considerably in the past few years, and now, many people are confused as to how to choose the best plan for their needs. The centralized government insurance exchange helps people to be able to see a variety of providers in one place, but it can be difficult for people to choose the plan that is right for them. There are several factors that go into determining which healthcare provider is the best for your needs, and you will have to do some homework if you want to get your selection right. It is important to remember that there is a limited window each year when you can choose your healthcare plan, so be prepared and make your choice before the deadline passes.
Understand the Coverage
- Be sure to find out which coverage in each planis standard and which coverage is optional.
- If you have special healthcare needs, then try to find a plan that will pay for as much of your care as possible without taking too much out of your pocket.
- Check to see if the plan you are considering has coverage for each member of your family.
- Always look for preventative care coverage such as immunizations and annual check-ups.
Costs of Coverage
- Understand the out-of-pocket costs you would have with each plan you are considering, and choose the plan that keeps the costs to you down.
- Utilize online healthcare cost calculators to find out what your healthcare costs would be for your situation. Every situation is different, so be sure to get as many details as you can.
- The government has set up the opportunity for people to get premium tax creditsthat will help to offset healthcare costs. Check to see if you qualify for a tax credit, and use that when calculating your costs.
- Your deductibles will determine how much you pay out of your pocket and how much your insurance plan will cover. Take the time to understand your deductibles before making a decision on which plan you want.
- Medicarecould be a cost-effective way for you to get the healthcare you need. Medicare is generally offered to the elderly, but you should check your eligibility to see if you qualify.
- Medicare offers several different optionsthat can enhance your coverage. You should check out the different options available such as advantage plans, dental plans, and supplemental plans and see if you can put together an overall plan that fits your needs.
Understanding the ACA
- The most significant change to occur in the healthcare industry in recent years has been the Affordable Care Act. There are laws regarding who must have insurance coverage and consequences for those who do not get insurance. Before you choose an insurance plan, make sure it qualifies under the ACA and you will satisfy your federal obligation to avoid any tax penalties.
- The ACA has a strict set of guidelineswhen it comes to availability of tax subsidies and who qualifies as being covered by health insurance in a household. When you understand these guidelines, you can make a better decision on which healthcare program is right for you.
What Is Medicaid?
- Medicaidis a federally outlined medical program for low-income families that is administered by each state. While there are federal guidelines for Medicaid, each state establishes its own eligibility requirements.
- When the ACA was passed, many states opted to not expand Medicaid. This means that health insurance for low-income families may not be as readily available in those states as it is in others. If your state did not expand Medicaid, then you should contact the state’s health department to determine your available options.
- Most states have a Medicaid component that is specifically set up to provide for the healthcare of children. Even states that did not expand Medicaid offer access to these programs, which makes this a healthcare option for the children of low-income families.
- To assist with the requirements of the ACA, many states have healthcare cooperatives and other options available for people who cannot afford health insurance. It is important to remember that there are always options to explore when it comes to getting health insurance.
- The fines for not having health insurance can be very stiff, so it is imperative that every family investigate their healthcare coverage options to avoid having to pay these fines.
- Healthcare coverage is definitely a buyer’s market, so use your ability to choose to your option. When you investigate the healthcare plans available, compare them side-by-side to make sure that you get the best possible plan for your situation