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Whether you are self-employed, work part-time, are unemployed, retired, have a change in family status, or leaving your parent’s coverage, there is a plan for you.  Even if you are employed full-time you may find your employer doesn’t offer health coverage or it’s too expensive or inflexible for your needs. You need coverage to protect yourself and your family. After all, a single medical event could quickly destroy a budget and bankrupt a family.

Overwhelmed by your wide variety of options?  We’re here to help!

Understanding networks & health insurance

When you buy insurance with a network plan, you benefit from a group of doctors who agree to offer services at a discounted rate to the network members.  This is one benefit that leads to less expensive services.  Using a physician inside a network will be more affordable than going outside a network.

You do have the choice of physicians outside the insurance company’s network, but generally the network discount won’t apply.  However, out-of-network health care costs may still apply towards your deductible amount.  Each insurance plan has its own rules about how out-of-network doctors are billed. Carefully review your health plan, so you understand how out-of-network services work with your coverage.

See a list of in-network physicians by the carrier

Finding the right plan

Did you know that with the newest laws, preventive care, such as routine vaccinations, physicals and cancer screenings, are 100% covered.  You don’t need to meet your deductible to take advantage of these benefits.  As long as an in-network doctor provides the service, coinsurance and copayments are not required.

If you’re in good health and fairly young, you may want to consider a plan with a higher deductible and a lower monthly premium. This would be an “emergency” plan, designed to help you if an unexpected but expensive medical event happens. If you’re older and/or have health concerns or you have a large family, you may want to pay more per month with the security of a lower deductible and more robust plan.

High Deductible Plans

The high deductible health plan (HDHP) requires you to pay a set amount, usually a few thousand dollars, before your insurance coverage kicks in. This upfront payment is called a deductible.  These plans have a lower monthly premium but require the higher “up front” cost.

A high deductible plan might be right for you if you don’t visit the doctor often and you can set aside some money to pay the upfront costs when they arise.  For example, if you can put $3,000 in the bank, then you may have some or all of the money to pay for your calendar-year deductible. Your insurance will kick in for covered expenses after you exhaust your deductible. The lower monthly premiums make this an attractive plan for the right person.

HSA Compatible Health Plans

The Health Savings Account (HSA) plans combine the lower-cost, high deductible health insurance plan with a tax-advantaged health savings account.   The HSA allows you to deposit the money you save on premiums into your tax-favored HSA account, subject to annual federal limits. Then, you use these savings to pay your qualified health care expenses (IRS Publication 502) until you meet the out-of-pocket maximum on your plan.  Let your unspent savings roll over year after year and earn interest. This plan works well for people who want more control over how health care dollars are spent, want lower monthly premiums and prefer to take advantage of the tax savings.

Copay Plans

With a copay plan, you will pay a set amount each time you go to the doctor. This is called a copayment. After the co-pay and lower deductible or no deductible, your insurance pays the remaining portion of your covered costs.  These plans have a higher monthly premium, but lower out of pocket or “as-you-go” costs.

This plan works well for people who regularly take prescription drugs, since they can better manage their expenses with a copay plan.Also, those who need to visit the doctor frequently; such as a family with smaller children who have regular doctor visits. This type of plan can benefit by paying a set amount at each visit.

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