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by Joseph Burns Health Insurance Contributing Editor

Since the Patient Protection and Affordable Care Act (ACA) was passed into law, providers have developed more health insurance choices to encourage consumers to purchase their coverage. Use our guide to research the best health insurance provider for you. We explain what to look for in different types of health insurance plans and how to choose the right fit for you.

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    What to look for in health insurance

    Out of pocket costs (also called coinsurance)

    Out of pocket costs are deductibles and co-payments that consumers pay to health care providers, usually at the time of service. Under the ACA, out-of-pocket limits apply to almost all health plans regardless of size or funding type, including all plans sold through a public insurance exchange. The only health plans that do not have out of pocket limits are those that the law defined as grandfathered plans. These are plans that existed when the law passed and that have not been revised since then. As soon as an insurer revises a grandfathered plan, the plan is no longer grandfathered and must meet the rules of the ACA that all health insurance plans must meet.

    Co-pays

    Co-pays or co-payments are fees that consumers pay to health care providers such as physicians or hospitals usually at the time of service although some physicians and other providers will bill consumers for copayments. Deductibles are a form of co-insurance, meaning the insured pays part of the cost of the insurance. Co-payments are another form of co-insurance. Deductibles are another form of co-insurance.

    • Routine visit co-pays: Consumers pay a fee up front when they go to a routine doctor’s appointment.
    • Prescription co-pays: Consumers pay a fee or a percentage of the cost of prescription medications, and the insured pays the remaining cost of the prescription, making medication more affordable.
    • Emergency visit and hospitalization co-pays: Co-pays for hospitalization or emergency services are usually higher than co-pays for routine visits, but are still far less expensive than paying for the entire cost of a medical emergency or hospitalization out of pocket.

    Deductibles

    Deductibles are amounts consumers must pay out of pocket either at the time of service or via payment after receiving a bill from a physician, hospital, or other provider. Generally, consumers choosing plans will find that they must pay a higher deductible in exchange for a lower health care premium.

    Out-of-pocket max

    The ACA sets limits on deductibles, coinsurance and co-payments and these limits are called the out-of-pocket maximum or out-of-pocket limit. The out-of-pocket max is the most a consumer would pay during a policy period (usually one year) before the health insurance company would for all covered essential health benefits. This limit includes deductibles, coinsurance, co-payments, or similar charges and any other expenditure an individual must make for a qualified medical expense for the essential health benefits. Under the ACA, this limit does not include premium payments or balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits.

    Essential health benefits

    The ACA defines essential Health Benefits as set of health care service categories that each health plan must cover in the individual and small group markets, both inside and outside of the Health Insurance Marketplace. Included among the essential health benefits are items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. To be certified and offered on the Health Insurance Marketplace, all health insurance policies must cover these essential health benefits, and states that have expanded or that will expand their Medicaid programs under the ACA must provide these benefits to those newly eligible Medicaid beneficiaries. Under the ACA, each state can define its essential health benefits as long as they fulfill the minimum requirements of the 10 categories.

    Types of health insurance plans

    On the Health Insurance Marketplace, five different levels of plans are available. They are bronze, silver, gold, platinum, and catastrophic plans. Among bronze, silver, gold, and platinum plans, the premiums are lowest for bronze plans and deductibles are highest. Silver plans have slightly higher premiums and slightly lower deductibles, gold plans have still higher premiums and lower deductibles and platinum plans have the highest premiums and the lowest deductibles. Consumers shopping for coverage would do well to determine what they might pay in the coming year based on past experience and then determine if paying more in a monthly premium helps save money overall because the individual or family’s deductible would be lower. Some studies have shown, for example, that while most people shop on price based on the premium and choose bronze plans when many would be better off to buy silver plans.

    Catastrophic plans

    Under the ACA, catastrophic plans cover all essential health benefits after the consumer reaches his or her out-of-pocket maximum ($6,850 for an individual in 2016) and they cover as many as three primary care visits per year with no cost-sharing, and, like all plans, preventive care is covered in full with no cost-sharing. But the insured with a catastrophic plan must pay for almost all other services until he or she reaches the out-of-pocket max.

    Not all consumers can purchase catastrophic plans because they are designed for consumers under age 30 or those who are older than 30 but who qualify for a hardship exemption under the ACA. Such an exemption would be granted for an economic hardship and would exempt the consumer from the individual mandate, meaning the consumer would not need to purchase health insurance or pay a penalty for failing to do so. Catastrophic plans also are available for those whose health insurance policies have been canceled for failing to comply with the ACA. While catastrophic plans are available from private insurers on the federal and state health insurance exchanges, only the Health Insurance Marketplace can issue a hardship exemption.

    Home health care services coverage

    Health insurance may cover the cost of home health care services for people who require them.

    • Full-time aide: If a patient needs a full-time health care worker to assist with basic self-care, the health insurance plan may cover the cost of the aide.
    • Visiting nurse: Some insurance policies cover the cost of a visiting nurse who checks with a patient at home on a regular schedule, such as a daily or weekly.
    • Home health care equipment: Some health plans cover the cost of equipment such as rails on bathtubs or blood sugar testing apparatuses that allows patients to manage their health care condition at home.

    Long-term care insurance

    Long-term care insurance covers health care services that are needed over many months or years, such as personal and custodial care in an insured person’s home, a nursing home, a long-term care facility, a community organization, or other setting. These policies pay insured individuals for assistance with activities of daily living such as bathing, dressing, and eating.

    What are different types of health insurance?

    Health Maintenance Organizations (HMOs)

    HMOs provide health care coverage for services within their networks. Consumers must visit doctors, hospitals,and other health care providers that are in-network, meaning they have a signed contract to provide coverage to members of the health plan. To see a specialist, members must get a referral either from their primary care physician or from the health plan itself. Without such a referral, the HMO will not cover the specialist’s care.

    Preferred Provider Organizations (PPOs)

    PPOs allow customers to choose between in-network and out-of-network providers at the point of care. That means members of a PPO plan can go to an in-network physician, hospital, or other health care providers to receive care or go out-of-network. In-network providers usually cost the consumer less than out-of-network providers, and out-of-network care usually is not covered unless the consumer gets a referral from his or her primary care physician or from the health plan itself. As health insurers seek to control costs, they are offering more HMOs and discontinuing their PPO options.

    High-Deductible Health Plans (HDHPs)

    HDHPs allow consumers to save money by offering high deductibles in exchange for lower monthly premiums. Consumers can combine these plans with health savings accounts that allow consumers to use pre-tax funds from an employer or other source to pay for a wide variety of health care services including those that might not be covered under a typical health insurance plan.

    Catastrophic Health Insurance

    Catastrophic health insurance covers only emergency services. Routine visits and prescriptions are not covered and consumers often must pay very high deductibles before insurance kicks in.

    Who buys health insurance?

    Students

    By law, anyone over the age of 26 must have his or her own health insurance. Many young people who no longer qualify for their parents’ health insurance are students; they often purchase health insurance through their school, which allows them to use student health centers for their health care needs. Students may also purchase catastrophic insurance to cover emergencies that cannot be treated at school.

    Employees

    Many employees purchase health insurance at reduced rates through their employers, although they may also purchase insurance privately or open a health savings account. Employees sometimes purchase insurance for spouses or children through their employer as well.

    Heads of Families

    Heads of families often purchase family plans that allow them to cover the health insurance needs of all family members who are age 26 and younger.

    Senior Citizens

    Seniors often have special health care needs due to advanced age and chronic or pre-existing medical conditions. Although seniors are often entitled to Medicare coverage, many purchase supplemental health insurance to cover health care needs that Medicare does not address.

    Health insurance FAQ

    How much is health insurance a month for a single person?
    In the U.S.:
    • The average monthly health care cost, or premium, for a single person, is about $440 a month.
    • The average premium for family insurance coverage is about $1,168 a month.
    • The average premium for group insurance, also called company-based health insurance, is around $574 a month; however, as most companies pay roughly 82% of the premium, individuals only pay about $103 a month.
    How do I get cheap health insurance?

    To get the cheapest health insurance, follow these steps:

    1. Start by deciding what you need:
      • Do you require many prescriptions?
      • Do you have a preexisting condition and need to visit a specialist regularly?
      • How much can you afford?
    2. The next step is exploring all your health insurance options. Depending on your income, family situation and available state programs, you may be eligible for Medicaid or lower-cost insurance plans.
    3. If you are ineligible for subsidized insurance or the premiums are too high, don’t be afraid to shop around. There are many health insurance company websites that give you the ability to compare costs.
    4. You can also explore catastrophic health insurance — essentially, basic insurance coverage that assists you in case of emergencies and covers preventive care. Catastrophic insurance plans come with very high deductibles.
    Remember, any insurance plan that offers low premiums with high deductibles means you pay less per month but more for doctor visits.
    Can I buy private health insurance?
    Yes, you can obtain private health insurance from an insurance agent or broker. However, you should be aware that:
    • A health insurance broker carries plans from multiple insurance providers.
    • A health insurance agent works for a specific company and only offers plans from that carrier.
    Don't forget to explore Affordable Care Act (ACA) coverage options found on the federal health insurance marketplace, where you can can price and compare plans.
    How do I choose a medical plan?
    When choosing a medical plan:
    • Assess your current health situation. Do you have a preexisting condition requiring regular prescriptions or the help of a specialist? Are you young and in good health? These questions factor into your insurance requirements.
    • Consider how much you can afford for a premium (monthly cost) and deductible (out-of-pocket expenses before insurance).
    • Think about how you want to choose your doctor.
      • A PPO allows you to choose a doctor outside of its network.
      • An HMO or EPO only allows you to use doctors in its network.
    Do senior citizens get free health care?
    All seniors citizens 65 and over are entitled to Medicare, a federal health care program that covers services for seniors. The federal government divides Medicare into two different parts — Parts A and B — which cover different services. Seniors can also purchase Medicare supplemental plans (Part C).

    Individuals under 65 may qualify for Medicare if:

    • They have been receiving Social Security Disability Insurance (SSDI) for more than two years.
    • They have amyotrophic lateral sclerosis (ALS).
    • They are currently experiencing end-stage renal disease and have paid Social Security taxes for a specific length of time.
    How much does it cost to see a doctor without insurance?
    The prices for doctor visits can depend on the cause and severity of your medical issue. However, the average cost of a doctor visit is:
    • About $68 for a 10-minute examination of a minor issue for a new patient
    • About $234 for a 40-minute visit regarding a more complex issue for an established patient
    There are also many clinics that offer free or income-based prices for uninsured patients.

    Author reviews for health insurance companies

    Humana Health Insurance

    Humana is one of the largest and best-known health insurance companies in the United States. It offers health care services for individuals, business owners and military personnel.

    Read more about Humana Health Insurance
    Aetna Health Insurance

    Aetna has been providing health insurance to Connecticut residents since 1853, and today covers people in all 50 states. It is a pioneer in health care legislation and is responsible for making coverage of genetic testing and counseling an industry standard.

    Read more about Aetna Health Insurance
    United Health Care

    UnitedHealthCare is the largest single health care carrier in the United States. It currently covers approximately 70 million Americans and contributes large amounts of money to medical research every year.

    Read more about United Health Care
    Kaiser Permanente Insurance

    Kaiser Permanente is a unique health care management program that is located mainly in the western United States. In California, Colorado and seven other states, patients who have Kaiser coverage get health care services, including hospital stays, at Kaiser health facilities.

    Read more about Kaiser Permanente Insurance
    Cigna Health Insurance

    Cigna is a worldwide health insurance organization that covers individuals, families and employers. It has been in business for over 30 years.

    Read more about Cigna Health Insurance
    Anthem

    Anthem is one of the better-known national insurance companies. It operates under different names, depending on what state a patient is from, but covers patients throughout the United States.

    Read more about Anthem
    Sun Life Financial Disability Insurance

    Sun Life Financial offers long-term and short-term disability insurance in addition to its many different benefits packages. This disability insurance helps you keep getting paid in the event that a disability prevents you from performing duties at work.

    Read more about Sun Life Financial Disability Insurance
    Health Net

    Health Net offers coverage to people in Arizona, California and Colorado. It is a California Market Plan associate, which means that low-income patients in California can get discounted insurance via Health Net under ACA rules.

    Read more about Health Net
    AUTHORIZED PARTNER
    United American Insurance

    United American began in 1947 as a one-man enterprise. Today, it is a national health care insurer based in Texas.

    • Several Medicare plans: Senior citizens will appreciate being able to choose between a variety of Medicare plans; they can choose the plan that best meets their needs.
    • Critical illness and cancer plans: Consumers who cannot work due to injury or serious illness can get critical illness coverage, which offers cash benefits for the duration of a disability.
    • Short-term and supplemental insurance: Consumers can short-term insurance while waiting for their permanent insurance to take effect.
    • Specialized insurance: United American specializes in Medicare and supplemental insurance, meaning those who are under 65 may not find plans that meet their needs, in part because most plans are geared toward seniors and those who just need a supplement to other health insurance.
    • Plan limits: Due to the nature of its insurance plans, United American doesn’t offer much in the way of coverage for routine health care visits. Plans typically cover hospital visits and other emergencies.
    Read 243 Reviews
    American Republic Insurance Co.

    American Republic Insurance was founded just before the Great Depression, and it is now a national insurer offering customized health insurance plans.

    Read more about American Republic Insurance Co.
    eHealth

    eHealth is a private online marketplace helping individuals and families find Medicare, vision, dental and general health insurance plans. Consumers answer a few questions to get tailored insurance recommendations, quotes and plan comparisons.

    • Find a doctor: The company has a search tool that enables consumers to search for plans that allow them to stay with their current doctor.
    • Resource center: eHealth helps consumers understand how the Affordable Care Act works, provides definitions of various insurance terms and more. The company also offers an e-book titled 3 Steps to Understanding the Affordable Care Act.
    • Subsidy calculator: The company's subsidy calculator allows consumers to plug in information such as ZIP code, household income and household size to estimate how much financial support they might get from the federal government on health insurance.
    • More options: eHealth offers plans that meet Affordable Care Act standards, but that do not appear on state exchanges and do not qualify for subsidies.
    • Newsletter: The eHealth Newsletter delivers helpful updates and tips to consumers' mailboxes.
    HealthPlansAmerica

    Health Plans of America is not a health insurer. Instead, it provides consumers with competitive health insurance quotes for seniors, families, individuals, and young adults who want to save money by using the company’s website to request a free health insurance quote.

    • Free quotes: The company provides free insurance quotes for anyone interested in purchasing a new insurance policy.
    • Age-specific plans: Health Plans of America offers quotes and information about insurance for specific and specialized age groups, including seniors, young adults, and families with young children.
    • Helpful agents: The company's website offers useful search tools and access via telephone to representatives who guide consumers in choosing health insurers.
    • Wide range of plans: The company provides comprehensive information about traditional health insurance plans, but also offers a variety of plans, including HSAs.
    • Variety of contact methods: Customers can contact Health Plans of America by telephone, online and by e-mail.

    Compare Reviews for Top Health Insurance Companies

    by Joseph Burns Health Insurance Contributing Editor

    An independent journalist, Joseph Burns is the health insurance topic leader for the Association of Health Care Journalists and contributes to AHCJ’s Covering Health blog. He has also written about health policy and the business of health care for a wide variety of publications, including Healthcare Finance News, Hospitals & Health Networks, Managed Care magazine, Ophthalmology Management, TaxACT.com, and The Dark Report.

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