So. Many. Choices. I’m Overwhelmed! Which is the BEST Affordable Health insurance plan? Should I use an Insurance Agent?
Everyone searches for the BEST health insurance plans for themselves, their family, or business. But with hundreds of insurance companies and thousands of plans to choose from, this is a daunting task! Affordable health insurance means different things to different people, so you should find an insurance agent able to help you find the right policy.
On your own, finding the lowest monthly premium is easy. But finding a plan that minimizes your expenses while providing the health care you need requires research, an understanding of the insurance market, and a lot of time.
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You’ll save a LOT of time, lower your stress, and discover a better health plan if you turn to an independent insurance agent for advice.
- Do I Pay More if I use an Agent?
- What do I gain by working with an Agent?
- How do I know if the Agent I’m talking with is any good?
- Great Questions to ask your prospective Insurance Agent:
- QUESTION #1: “Is this health plan ACA-compliant?”
- QUESTION #2: Do I qualify for a premium tax credit?
- QUESTION #3: Do I Qualify for a State Insurance Subsidy?
- QUESTION #4: What is the limit to my out-of-pocket expenses for covered medical care?
- QUESTION #5: How much do I have to pay, before the insurer pays? (my deductible)
- QUESTION #6: What are the copays? (The fixed amounts I have to pay for certain services.)
- QUESTION #7: What is the rate of co-insurance for certain services?
- QUESTION #8: Are my medications covered by the insurers formulary?
- Question #9: Am I protected from surprise billing?
- Question #10: Can I keep my preferred Doctor(s) and medical professionals?
Do I Pay More if I use an Agent?
The price of health insurance is the same whether you enroll through the insurance company directly, enroll online through a health insurance marketplace, or use an independent agency. You DO NOT PAY MORE for your health insurance when you work with an insurance agent.
What do I gain by working with an Agent?
- Unbiased advice,
- The most extensive selection of ‘best for you’ plans,
- Accurate Policy Comparisons
- Claims Assistance
- Time Savings
- An Agency earns your ongoing business.
Agents have a vested interest in doing a great job because they live on referrals. When they do well, you are more likely to recommend them to others.
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Here’s the minimum information an Agent needs to provide a quick list of affordable Health Insurance Plans:
- Your age,
- The Zipcode where you live
- The number of family members and their health history,
- Tobacco usage.
Providing additional information will save you money. The more details you provide, the better able the Agent is to find the best health coverage for you.
How do I know if the Agent I’m talking with is any good?
There will be a few bad apples In any business, To avoid these people, refer to the “Questions to Ask” listed below.
A) Think twice: If you are pressured to commit right away. No one can offer you a ‘special deal’ or a time-limited ‘offer’.
B) Be suspicious: If the price is considerably lower than any other comparable plan from another company. Low-cost plans almost certainly offer FEWER BENEFITS and more set MORE LIMITATIONS on services and medication.
C) The ONLY time-sensitive date is the Open Enrollment period of the Affordable Care Act. (November 1st through December 15th)
If you are pushed to sign something right away, that’s a signal that something unscrupulous could be going on. (Again, with the exception of the ACA Open Enrollment deadline.)
Great Questions to ask your prospective Insurance Agent:
QUESTION #1: “Is this health plan ACA-compliant?”
ACA compliance means that you are covered for the 10 mandated health services. For a quick guide on what the Affordable Care Act requires of every ACA-compliant plan, check out our ACA Refresher Blog:
Making Sense: An Affordable Care Act Refresher & Quick Guide
QUESTION #2: Do I qualify for a premium tax credit?
Properly answering this question requires the Agent to gather additional information. Premium tax credits are based on your income, the entire household income if buying insurance for your family, and the State Marketplace insurance options.
Click below to determine your eligibility for a premium Tax Credit:
QUESTION #3: Do I Qualify for a State Insurance Subsidy?
If you are eligible to receive a premium tax credit and have household incomes from 100% to 250% of the poverty level, you are likely to be eligible for cost-sharing subsidies.
Cost-sharing subsidies work by reducing your out-of-pocket expenses. These include health care services like deductibles, copayments, and coinsurance. When enrolling in a “silver” insurance plan, an eligible enrollee is placed into a plan that automatically applies the health insurance subsidy.
QUESTION #4: What is the limit to my out-of-pocket expenses for covered medical care?
Typically, out-of-Pocket amounts range from $600 to $8150. For 2021 the out-of-pocket limit for a Marketplace plan is $8,150 for individuals and $16,300 for a family.
QUESTION #5: How much do I have to pay, before the insurer pays? (my deductible)
NOTE: Understanding deductibles is VERY important. Typically, the lower the monthly premium, the HIGHER the deductible. Depending on the # of visits to healthcare professionals, and the medical treatments you receive, deductibles can cost far more than the money you saved with a lower premium amount.
The deductible is the amount you pay for covered health care services before your insurance plan starts to pay. For example: With a $2,000 deductible, you pay the first $2,000 of covered services yourself.
- Some plans have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.
- Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list
QUESTION #6: What are the copays? (The fixed amounts I have to pay for certain services.)
NOTE: Understanding Copays is VERY important. Typically, the lower the monthly premium, the HIGHER the Copay. Depending on the # of Doctor visits and the medical treatments you receive, Copays can cost far more than the money saved with a lower monthly premium.
Copays are the amount you pay when medical services are received. The insurer is responsible for the rest of the reimbursement.
- There will be separate copayments for each different service.
- Many plans require that a deductible be met before a copayment applies
QUESTION #7: What is the rate of co-insurance for certain services?
NOTE: Understanding Coinsurance is VERY important. Typically, the lower the monthly premium, the HIGHER the Coinsurance. Depending on the # of visits to healthcare professionals, and the medical treatments you receive, Coinsurance can cost far more than the money you saved with a lower premium amount.
Coinsurance is your share of the costs of a health care service. It’s usually a percentage of the amount allowed to be charged for services. You start paying coinsurance after you’ve paid your deductible.
A) You’ve paid $2,000 in health care expenses and met your deductible.
B) The next time you go to the doctor, instead of paying all costs, you and your plan share the cost. If your Coinsurance is 30%, you pay 30 percent of the amount and your insurer pays the final 70 percent.
QUESTION #8: Are my medications covered by the insurers formulary?
“Formulary” is another term for “Approved List”. To find out id your medications are covered on your Marketplace plan, you’ll need to visit the insurer’s website to review a list of prescriptions covered by your plan. An Agent will help you with this research.
Question #9: Am I protected from surprise billing?
Surprise billing, or unanticipated billing, happens when you receive services from an out-of-network provider at an in-network facility and are then billed for those services.
If you received your healthcare at a place (like the hospital) that is in-network, you’d never expect additional billing for services by out-of-network providers. Hence the term: Surprise billing.
Click here to learn more about Surprise Billing.
Question #10: Can I keep my preferred Doctor(s) and medical professionals?
You’ll need to visit the insurer’s website to review which healthcare professionals are “in-network” on your plan. Your insurance agent can help with this research.
When you have the answers to these questions, you can decide on the best plan for your healthcare needs.
Obviously, cheap health insurance plans may not really be affordable health care plans in the long run.
The right plan for you and your dependents may have a slightly higher premium but could save you thousands. An independent insurance agent can help you make the BEST decision.