Simplifying The Health Insurance Shopping

In the past, it was very confusing comparing plans with all the deductibles, co-pays and provider network options. Who can really make a choice and really know what they had just selected for themselves or their family? Now the law has changed the design of the plans to try to make it easier to compare the plans. By adding change to the process it is about as clear as mud, right? The good news, it's really not that hard to figure out.
Making sense of health insurance has never been so easy. At least that is what the government thinks. Throw in a drastic industry change and just forget it. Hence all the delays, right? This gives another reason to work with a subject matter expert.
There are several easy ways to understand the new Metallic Plans going into 2014:
The metallic plans correspond with how rich or lean the plans are (in layman's terms). At the end of the year, the maximum deductible one could pay is $6,350 for an individual or $12,700 for a family. There still is co-insurance (cost sharing), with the individual maximum out-of-pocket is $6,350. Depending on the carrier that amount can be up to three times that for a family maximum out-of-pocket. In this example, that would be $19,050. That is truly a bad year and is uncommon for that to occur. If that does happen to your family, please go play the lotto, the chances could be similar.
  • Platinum plans - Typically less than $3,000 max out-of-pocket per person ($1,500 max on some plans) with co-pays for first dollar coverage. This is very rich and the premium will be unaffordable to most.
  • Gold plans - Roughly $3,000 out-of-pocket maximum per person including your deductible (this can vary based on personalities of the insurance companies). Your deductible could start as low as $500 or be at the max at roughly $3,000. This plan will also typically includes co-pays at the doctor, specialist and prescription drugs at the pharmacy. The amount of the co-pays will vary by carrier and service and/or tiers.
  • Silver plans - Roughly $6,000 out-of-pocket maximum per person including your deductible (this can vary based on personalities of the insurance companies). Your deductible would typically start around $2,500 and go up to the max of $6,350 per person. This plan will typically include co-pays similar to the Gold plans.
  • Bronze plans - Some refer to this as a low-level plan. There is nothing wrong with this plan. It's similar to the old Health Savings Account (HSA) plans. It is a high deductible and everything you do applies towards your deductible. All except for Preventive or Wellness exam (check policy for details). If someone is comfortable just know what their maximum out-of-pocket is without worries of co-pays and take a premium reduction for it, this is a great alternative to the other plans. This plan will be a maximum out-of-pocket of $6,350 for individual and $12,700 for a family. This will vary depending on the personalities of the insurance company you are reviewing.
  • Catastrophic plan - This plan is for the young. It's basically mirrors the Bronze plans but it will have a doctor co-pay attached to the plan. It's an alternative for the young to get something more affordable with a co-pay for first dollar doctor visit coverage. There are age limits to this plan. However, with certain financial hardship, those over the age limit may qualify.
For those who qualify for tax credit may also qualify for a cost sharing credit. This will reduce your out-of-pocket expenses on the Silver plan. There are several variables that will determine how much of a reduction in deductible and out-of-pocket expenses. See an insurance advisor for more details.
All of the above plans have first dollar preventive and wellness coverage. This means the insurance company pays for yearly exams. These are yearly exams that most take and are on a list of covered benefits. Just because you use the word 'preventive' or 'wellness' does not mean that is what is billed to the insurance company. It all comes down to the billing code that is used when it is sent to the insurance company. A short list will include:
  • Routine lab work
  • Pap Smear/Mammogram
  • PSA Screening
  • Colonoscopy
  • Immunizations
The purpose of this is for you to use it as a guide. Each health insurance company has their own personality and twist to how the plans will look. Each state will have certain mandates that will change some of the information above. Plans are always subject to change, along with many of the other delays that have already occurred and will occur with healthcare reform and the Affordable Care Act (ACA). Be sure to get advice from a true subject matter expert to stay up to speed and make educated decisions.
By Butch Zemar

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