Shopping for a health plan does not have to be difficult or break the bank. Scott & White Health Plan, part of Baylor Scott & White Health, has some useful information to help you find the right coverage for you and your family.
The key to finding the right health insurance is shopping smart. This means being informed on three major points:
- The basics of health care reform
- How health insurance payments work
- Different levels of coverage
Health Care Reform
The Affordable Care Act (ACA) was introduced to make health care more accessible for all Americans. The law limited costs for coverage, guaranteed a basic set of benefits regardless of the plan chosen, and insured that citizens with pre-existing conditions would not be charged more or denied coverage based on their health. The law also made coverage mandatory, meaning that a citizen or family without coverage would pay a tax penalty based on income. In 2015, this penalty will be 2% of your income or $325 per person, whichever is more. For families, the penalty will be 2% of family income or $975, whichever is more.
To help make health insurance more affordable, recent healthcare reform also introduced cost savings in two forms: advanced premium tax credits, which help with monthly premium costs, and cost-sharing reductions, which make the shared cost at the time of service less. Last year, 87% of people who signed up for insurance under the new health care law received some form of cost savings.
Health Insurance Payments
Most health insurance plans have three different phases of payment:
- Before reaching your deductible
- After reaching your deductible
- Once you’ve reached your out-of-pocket maximum
Reaching the deductible
The deductible is the amount you have to pay each year until your plan begins to pay for covered services. Until you reach your deductible, you have to pay for almost all of your care. After that, your plan pays what’s called coinsurance. That’s their part of the costs for covered services. Your deductible does not include your copayment. Your copayment is a set amount you often must pay at the time of service.
Once you’ve reached your deductible
After you have paid your deductible, you pay for only part of your care. During this phase, you pay a
percentage of some medical costs. That’s called coinsurance. You also pay a flat fee called copayments, or copays. Your plan pays for the rest.
Your out-of-pocket maximum is the most you can pay in a single plan year. After that, your plan pays
all of your covered care. Your deductible, coinsurance, and copays all go toward reaching your out-of-pocket maximum.
For 2015, all plans must cover certain types of care, known as essential health benefits. These are:
- Ambulatory services such as primary care and specialist visits
- Maternity and newborn care
- Emergency services
- Prescription drug services
- Pediatric services
- Mental health and substance abuse services
- Rehabilitation and habilitation
- Lab services
- Preventative care, wellness, and disease management
Since all plans cover the same types of care, you need to look these factors to find the best plan for you:
- Network – Does the plan allow you to see the doctors that you want to see without having to pay extra
- Formulary- A formulary is the list of prescription drugs that a health plan will cover. Is your prescription included on the formulary?
- Costs/Coverage amounts- ACA plans come in different coverage levels called metal levels. These levels tell you how much of your health care costs the plan will pay. In general, the higher the monthly premium, the lower the out-of-pocket maximum.
- Catastrophic Level: Lowest premium, highest out-of-pocket costs.
- Bronze Level: Low premiums, high out-of-pocket costs.
- Silver Level: Balances monthly costs and out-of-pocket costs.
- Gold Level: Highest monthly premiums, lowest out-of-pocket costs.
If you have questions about your coverage options, want to find out if you qualify for cost savings, or need help enrolling in a plan, the staff at Scott & White Health Plan is available to help. Just call (844) 757-8999 or click here to view our plans.