Home / Start Ups / Investors / Cutting Your Cost for Marketplace Health Insurance

Cutting Your Cost for Marketplace Health Insurance

Love it or hate it, it looks like the health insurance marketplace is here to stay. As of late 2018, the key piece of the health reform law known as Obamacare may still be your best bet to get adequate health insurance if you’re not covered by an employer, a spouse’s or parent’s plan, or some other source. And if you’re getting by on a low income, browsing the marketplace is a must: You may well be eligible for a federal subsidy that will cover a big part of the monthly cost of your coverage.

You have to act fast: The open enrollment period for coverage for 2019 has shrunk to just six weeks, from Nov. 1, 2018, to Dec. 15, 2018.

Even if you don’t qualify for a subsidy, the marketplace may be a good place to start your search for decent coverage that you can afford. The plans listed there are required to offer the basic routine and emergency care that you and your family may need. These include:

  • Addiction treatment
  • Ambulatory patient services
  • Care for newborns and children
  • Chronic disease treatment (such as diabetes and asthma)
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity care
  • Mental health services
  • Occupational and physical therapy
  • Prescription medications
  • Preventive and wellness services (such as vaccines and cancer screenings)
  • Speech-language therapy 

One important point: If you qualify for a subsidy you must buy your plan through the marketplace. During the enrollment process, you’ll learn whether you’re eligible for a subsidy and how much it will be, how much you will owe and how to pay it.

Getting Started in the Marketplace

To get started, www.healthcare.gov or to your state’s version of the site, if it has one. As of this date, about half of the states have a version of the exchange, and at least four more are considering introducing one. Whether your state has one or not, the federal marketplace will do.

The marketplace allows a quick side-by-side comparison of the plans that are available to you. Health insurance in the U.S. has become highly Balkanized: The plans you are able to buy and the costs of them may vary even by zip code. 

The database allows you to choose from four tiers of health insurance: Bronze, silver, gold and platinum. Bronze is the least expensive but requires the highest co-pays and deductibles for some services. Platinum may have more bells and whistles than you want or can afford.

Comparing Health Plans

Plan LevelPayment Percentage

 Silver Plan “A”Silver Plan “B”
Premium (annual)$5,836$3,408
Coinsurance20% after deductible30% after deductible

As the table shows, Plan A will cost you more up front for your monthly deductible, but your out-of-pocket expenses will be much lower. Conversely, Plan B will cost less each month, but you will pay more for healthcare expenses because of the higher deductible, copayment and coinsurance amounts.

Reducing Costs on Silver Plans

Tip: In order to receive Cost-Sharing Reductions, you must enroll in a Silver plan through the Health Insurance Marketplace and apply for the subsidy. And it’s important to note, the cost-sharing subsidies only apply to in-network expenses, so you have to be mindful about where you receive healthcare.

Using Advanced Premium Tax Credits

Estimating Your Subsidy

The exact subsidy you qualify for may not be quite as simple as the match above. The Kaiser Family Foundation calculator is an online tool that shows the subsidy you might receive based on your expected 2019 income, the number of adults and children enrolling in coverage, their ages and whether any of them use tobacco. 

Tip: In order to receive this subsidy, you must apply for Advanced Premium Tax Credits on the Health Insurance Marketplace. This subsidy is not automatic. If you qualify, you can take advantage of both Cost-Sharing Reductions and Advanced Premium Tax Credits to reduce both your monthly premium and out-of-pocket costs.

Choosing Catastrophic Coverage

A catastrophic health plan covers three primary care visits per year before the deductible is met. It also covers preventive services at no cost to you.

The premium you pay each month should be considerably lower than for other plans, but the out-of-pocket costs (deductibles, co-payments and co-insurance) are generally much higher.

You may be eligible for a catastrophic plan if you are under 30 years old or if you qualify for a “hardship exemption,” because you are unable to afford health coverage. This is determined during the application process and is based on your family size and income.

Qualifying for Medicaid

Many states also have a separate program, the Children’s Health Insurance Program (CHIP), which provides health insurance for uninsured children in low-income families who do not qualify for Medicaid but cannot afford private coverage. You can fill out an application on the Health Insurance Marketplace to find out if you are eligible for Medicaid or CHIP benefits. You can also visit your state’s Medicaid website to apply and find out if you qualify.

The Bottom Line

Source link

About Amy Harvey

Amy R. Harvey writes forStartUps Sections In AmericaRichest.

Check Also

5 Broker Deals That Pay You to Open an Account

If you’re looking for a new brokerage, consider opening your account with one of these …

Leave a Reply

Your email address will not be published. Required fields are marked *