Daniel Cook

Health insurance policies can really pay off if you’re ever faced with hard-hitting medical conditions which could result in massive medical bills. Depending upon the type of health insurance policy, either you have to pay costs upfront and get a reimbursement later, or the insurance agent or company directly pay to the hospital.

Why is insurance premium so high in the US?

  1. Huge salaries and commissions to insurance agents – Insurance companies incur high administrative and operational costs which they recover from the insurers by charging high premiums.
  2. A threat of no subsidies – Obamacare funded cost-sharing deductions due to which premiums were low. Future of Obamacare is uncertain due to which companies have increased the premium to set-off the subsidy amount.
  3. Unawareness among the young people – Young people don’t opt for insurance policies. By the time they understand its importance, the insurance premium shoots up.

What if you don’t opt for health insurance?

  1. Expensive Health Care – Due to high administrative and drug costs, health care in the US is twice expensive as compared to other developed countries. Preventive care and follow-up tests can be sky-high. If you don’t opt for insurance, you may end up paying huge bills.
  2. Pay health-care tax penalty - If you can afford but don’t have coverage in 2018, you have to pay a health-care tax penalty. In 2017, it was $695 per adult or 2.5 % of annual income (whichever is greater).
  3. Ruin the credit history - A sudden or serious illness or an accident can hit hard on the pocket. Inability to pay the staggering medical bills may cause to file bankruptcy which can ruin the credit history.

Where to buy the policy?

In the US, there are two types of health insurances - Public and Private. In public health insurance, the state subsidizes the healthcare in exchange for a premium. Selecting an affordable health insurance policy may be a daunting task, However, we’ve compiled a couple important things to consider when applying for your Health policy. Search & compare various options/providers before selecting a policy for your specific needs. Affordable Care Act (ACA) has set up insurance exchanges from where you can buy inexpensive health insurance policies through state or federal exchanges. They also give discounts and tax credits on monthly premiums for people with low or moderate income.

You can also buy the policies through

  1. Insurance Companies
  2. Captive or Independent Agents
  3. Online Insurance aggregators

What are the categories of marketplace plans?

There are 4 main categories – Bronze, Silver, Gold & Platinum where the insurance company pays 60%, 70%, 80% & 90% of the expenses respectively.

What are the types of marketplace plans?

Following are the 4 main types of market plans you should check out:

a) Exclusive Provider Organization (EPO): This plan covers the services only if you opt for doctors, hospitals and specialists within the specified plan’s network. Emergency services are excluded.

b) Health Maintenance Organization (HMO): HMOs generally concentrate on prevention and wellness. You are covered under the plan only if you live or work in its service area. Here also, services related to the specified plans’ network are covered except emergency services.

c) Point of Service (POS): If you want to visit a specialist, your primary care doctor will refer you to him/her. Here, you can pay less by using your plans’ network’s doctor and hospitals.

d) Preferred Provider Organization (PPO): You can visit a specialist without reference from the primary care doctor, but you’ll have to pay additional costs/premiums to get the services covered in your plan.

What are the cost-sharing expenses?

Out-of-pocket expenses can make the policy expensive which otherwise looks economical. Check the deductible and be sure that you’re able to pay that amount at short notice, anytime. The deductible is the amount you have to pay upfront for health care services before the policy activates to pay for the covered services.

What is the network coverage of the insurance company?

Check whether the plans and the insurance company’s network of doctors and hospitals cover your preferred doctors and specialists. If you always visit a preferred doctor, take up the policy from a company who covers the services of your specific doctor. If not, consider a policy that has a large network and covers many doctors and specialists.

When a doctor within the network of the insurance policy provider treats you, the costs will be lower as compared to a doctor who isn’t covered by your policy provider.

Which option gives better perks and benefits?

Check the options which give better and more services particularly required by you or your family members. Check if your health concerns, medication issues and/or foreseeable medical conditions are covered by the plan. If they’re not covered by the plan, you may end up paying higher out of pocket expenses.

Before choosing your beneficial health care insurance, it is important to evaluate all the options on the basis of network coverage, benefits, premium and overall suitability. Since so many options are available, it is important to narrow down the insurance plans and providers on the basis of some criterion and then select the one that best suits your current and foreseeable needs.


1. https://www.healthinsurance.org/obamacare/

Related Article