Individual Health Insurance 101
There are four basic elements to individual health insurance coverage. Consulting each element will help you make wise healthcare decisions.
1. Major Medical – The Affordable Care Act requires that everyone must have a healthcare plan with “minimum essential coverage.” If you don’t have this type of healthcare plan, you will have to pay a penalty. Century Benefits can help you find a plan centered on your total risk (or maximum out of pocket expense). Your deductible plus your coinsurance per calendar year is your total risk. Coinsurance is the percentage you pay (up to a set limit) after you meet your deductible. The level of risk can vary greatly, and so can your network of providers.
2. Prescription (Rx) – Most plans include prescription coverage. A plan may cover medications on a co-pay or coinsurance basis. Rx care may easily be the most expensive part of a consumer’s health care costs. Costs of medications are continually on the rise, and these costs need to be considered when you choose a health insurance plan.
3. Doctor Office Visits – The Affordable Care Act requires that insurance plans cover a range of preventive services at no cost to consumers (you don’t need to reach your deductible for them to be free). A list of preventive services available without a copayment or coinsurance is provided here. The caveat is that the services are free only if they are performed by a doctor in your network. However, there will be charges for doctor office visits that are not considered “preventive care.” Premiums vary depending on the type of insurance plan (as do the physicians who work within particular provider networks). Century Benefits agents are here to help you find the best health insurance plan for you.
4. Additional Benefits – We recommend adding an accident policy to health plans to help lower your total risk in the case of an accident. The supplement will fully cover (and pay down) your maximum out of pocket in the event of an injury. Typically, if you use your plan once in 8 years, then the plan pays for itself.