Health Insurance Can Be A Very Confusing Topic, So We’ve Broken It Down

We realize that finding out the best healthcare plan can be a stressful and confusing experience, but as always, knowledge is power. Using these tips can help you make informed decisions to keep you safely covered in 2018.

November 20, 2017
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It’s that time of year again: open enrollment for the Affordable Care Act (ACA) is now available, and the process has never been more confusing—or stressful. Thanks to recent political upheaval, the process has been shortened from the normal 12-week period to just six.

But trying to figure out all the intricacies of a healthcare plan in a hurry can prove disastrous. This is one instance where you don’t want to ignore the fine print; there are many changes going through this year that you should be aware of.

So if you’re looking to find out what will be different about buying insurance—and what’s staying the same—here’s what you need to know to make sure you’re covered for 2018.

Healthcare Statistics and Coverage Options

Thanks to the Affordable Care Act, the national average of uninsured Americans has shrunk from 48 million in 2010 to just 28 million in 2017. More than 6.4 million Americans are estimated to sign up for 2018.

That could change. A recent executive order from President Trump now allows “bare bones” plans that could exclude those with pre-existing conditions. Likewise his decision to withhold Obamacare cost-sharing reduction subsidies may spur more insurance companies to leave the exchange. And that’s not all: A potential rollback of the individual mandate in the upcoming tax reform bill could destabilize the market if it were to pass.

Of course, enrolling through the healthcare marketplace isn’t the only option. More than 155 million Americans are covered under their employer, but you should review your coverage regularly. Companies are always looking to save money, meaning your plan could change dramatically year to year, from what premiums you pay to which insurer you use.

If you’re looking for options beyond the ACA or your employer for your insurance needs, an insurance broker is another option. Leslie Shields, health and life insurance agent for HealthMarkets in Fort Worth, Texas, notes that brokers like herself “work with HealthCare.gov, but we have other options as well, and we can help you compare what’s offered to you at your company or through a spouse or what’s available to you outside of that and can also help make specific laws and guidelines more clear.”

Choosing a Plan

When choosing a plan through HealthCare.gov, you have four options: Gold, Platinum, Silver, and Bronze plans. Gold and Platinum have lower deductibles but higher monthly premiums, while Silver and Bronze have lower premiums but higher deductibles.

One side effect of the aforementioned subsidies cut is cheaper (and in some cases free) plans, but keep in mind that if you need cost-sharing subsidies (i.e., if you make $12,000 to $30,000 a year individually or $25,000 to $62,000 for a family of four) you must choose a silver plan.

Jennifer Fitzgerald, CEO and co-founder of insurance comparison website PolicyGenius, says that whether you’re buying through the marketplace, your employer, or a broker, keep these questions in mind:

  • Which plan works with your income?
  • Are your medications covered?
  • Is your physician of choice in-network?

If the latter is particularly important, keep in mind that health maintenance organizations (HMOs) have a limited list of providers, whereas an exclusive provider organization (EPO) allows for more choices.

The Differences Between Premiums, Deductibles, Copays, and Coinsurance

Fitzgerald says that although the above terms can cause confusion, they can be broken down as follows: “Your premium is what you pay monthly, no matter what. It’s essentially the cost to have health insurance” whereas a deductible “is what you have to pay out-of-pocket before your insurance starts providing benefits.”

Copays are “a fixed cost that you pay for a service after you’ve reached your deductible. Similarly, coinsurance is a percentage you pay for a service after you’ve hit your deductible.”

Her website offers a list to compare these differences to pick the plan that’s right for you.

Open Enrollment Basics

As previously mentioned, the window for open enrollment is shorter this year. For those under 65 years old, it starts November 1 and ends December 15. For those on Social Security, it began October 15 and the cutoff is December 7. This means it’s crunch time to figure out what plan will best suit your needs (note some states have extended deadlines—click here to see what your state’s deadlines are).

It’s important to note: Just because you liked the plan you purchased last year, don’t default to “auto-renew.” The Kaiser Family Foundation has shared that existing plan premiums are up 35 percent from 2017. So it pays to shop around for a better rate, while also making sure you’re not losing benefits that you’re currently enjoying before it’s too late to purchase a new plan.

Shields says to keep an eye on your mailbox: “if you’re on a fully qualified plan you should be getting renewal packets in the mail from your insurance carrier that will tell you what your new plan is, and if you want to change that or look into other options you can.”

So what happens if you miss the deadline? Well you’re stuck with your plan until next year. And if you missed the deadline with no plan at all, Shields says a stopgap measure is to look for “an insurance alternative, including options like short-term insurance and indemnity products.”

Contraception Coverage

In addition to the aforementioned Trump executive actions on health care, there’s one that explicitly affects women: contraception coverage. The administration is ending the Obama-era requirement making contraception free on employer-based health plans.

Going forward, any company that objects to paying for birth control on moral or religious grounds can make female employees pay for their contraception out of pocket.

For women who are worried that they may lose coverage, Shields notes that there’s not much data available yet about which companies won’t pay for contraception coverage in 2018, although this list (provided by Motto) covers 46 possible employers who might, based on past lawsuits against Obamacare rules.

This makes individual coverage more attractive, according to Fitzgerald, because “Anyone shopping for an individual policy will find contraception coverage included in their plan.”

Medicaid and Medicare

So what are the differences between Medicaid and Medicare, and how can they help lower your premiums?

Fitzgerald explains, “Medicaid is available to low-income families and older Americans, pregnant women, and people with disabilities. Additionally, some states expanded their Medicaid coverage under the ACA, so they receive more money from the federal government; it also increased the number of people who qualify for Medicaid.” Because this can offer sizable savings on your healthcare costs, she advises everyone to visit HealthCare.gov to see if you qualify.

She says that Medicare keeps “costs down by separating older (and likely less-healthy) people from the general insurance pool” but won’t have an effect on the average person’s premiums.  

Fitzgerald adds that low-income Americans who don’t qualify for Medicaid should look into subsidies: ”if you make between 100 and 400 percent of the federal poverty level, you likely qualify for federal subsidies to make your healthcare more affordable.”

Joel Ohman, who is a certified financial planner and the founder of MedicareInsurance.commentions another cost-saving measure many Americans are unaware of: “One of the single biggest things that people can do to save money on both monthly premiums and on future healthcare costs and to make sure that they have money available for medical expenses is to start socking money away pre-tax into a health savings account (HSA).”

Covering Your Kids

All current insurance plans cover children until they’re 26 years old. But what if you have a child after the enrollment period ends? Fitzgerald says that circumstance “qualifies you for a special enrollment period—basically allowing you to select a plan that provides the new level of coverage you’ll need.”

To add a new child to your plan, simply visit HealthCare.gov, a broker, or your state’s exchange plan.

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