Finding Affordable Health Care (Health Insurance) – How to Choose the Best Plans for Reliable Health Coverage
What are my options for affordable health insurance plans?
Many Americans are currently struggling to find affordable health coverage, and you might think that it’s impossible to find insurance plans that are both cheap and effective for your health.
However, there might be more options for affordable coverage than you think. While it’s true that the current ACA marketplace system offers little choice and competition between insurers, you can explore a range of alternatives outside of “Obamacare” that may be more cost-effective.
First of all, you should know that many Americans feel like they have no choice but to select only one option for health coverage.
For example, some employees simply accept whatever employment health plan their company offers them. According to recent statistics, more than half of Americans with health insurance fall into this camp.
If you’re satisfied with your employer’s group health plan, you probably don’t feel the need to switch. If it’s affordable and effective, why jump ship and abandon your group plan?
In addition, many other Americans are limited by their low income when it comes to health coverage, giving them only a few viable options. A clear example is Medicaid, which is a government program targeted toward the lowest-income Americans. Medicaid is especially helpful for retirees or those with a disability.
But what about everyone else?
For an individual who has a relatively solid income but lacks coverage through their employer, the obvious source of health insurance is the federally regulated Affordable Care Act marketplace.
Assessing your options can be a little challenging when you sign on to the government website and browse various plans. First of all, there might be only a few coverage providers in your state. Many individuals find that there is only one or two real options that serve their unique needs while remaining affordable.
Assessing your options can also be very confusing, especially if you’re not familiar with complex insurance terms like deductibles, annual expected costs, premiums, and so on. Even if you are familiar with these terms, it’s often challenging to do the math and figure out which provider offers the cheapest coverage.
It’s also worth mentioning that all Affordable Care Act plans must provide coverage for the same things. These are known as the “10 essential health benefits.” These benefits include:
- Emergency services
- Out-patient services
- Maternity and newborn care
- Mental health and substance abuse care
- Prescription drugs
- Rehabilitative and habilitative care
- Laboratory services
- Pediatric services (including oral and vision)
- Preventative care and chronic disease management
No matter which Affordable Care Act plan you choose, you will always enjoy coverage for the above treatments and services.
With that being said, there are a few things to consider when choosing an ACA-compliant plan.
Firstly, determine whether you need to wait for an open enrollment period before you sign up with a new insurance provider. If you’re going to experience a long wait, you might want to explore other, short-term options in order to fill your coverage gap.
You also need to consider the fact that certain premium subsidies are only available if you choose a “silver” ACA-compliant plan.
Another solid choice is to use online tools to get subsidy estimates while you search for plans on the marketplace, which gives you a more accurate sense of how much you’ll actually be paying for coverage.
Next, consider your state’s stance on health insurance mandates. If you will encounter a significant tax penalty for not choosing Obamacare, it might make more sense to stick with the Affordable Care Act marketplace instead of searching for alternative coverage.
That being said, you should always do the math and determine whether certain alternatives are more effective even after tax penalties are taken into account.
Types of ACA coverage
Affordable Care Act coverage is split into four categories:
- PPOs: Preferred Provider Organizations are very popular on the ACA marketplace for both families and individuals. The main benefit of a PPO is flexibility. With this type of coverage, you can choose any health care provider you like – as long as they are within your network. The key point is that you don’t need a referral from your primary health provider to do this, while this is a requirement for other types of coverage. PPOs are best for individuals who value freedom and flexibility with their health needs, and for those who need reliable coverage for out-of-network healthcare without having to get referrals from their primary care providers.
- HMOs: Health Maintenance Organization plans provide a wide range of healthcare services to members – more so than many other types of coverage. In 2018, it was reported that HMOs were the most popular ACA plans, with 53% of Americans choosing this option. You will also need to get a referral from your primary care physician if you want to visit a specialist. HMOs are probably popular due to the low out-of-pocket costs, although deductibles can limit the affordability of these plans. Copayments and premiums are generally quite low, and you will likely not need to pay a deductible for a normal visit to the doctor. Out-of-network services may not be covered. HMOs are ideal for young individuals who want to focus on preventative care early with solid affordability.
- POSs: Point of Service plans combine elements of both HMOs and PPOs. Like HMOs, POS plans revolve around primary care providers that refer you to specialists – and you typically don’t need to pay deductibles for normal doctor visits. But POSs also have elements associated with PPOs, including coverage for out-of-network services. However, out-of-network services with POSs involve higher deductibles and general costs compared to the coverage provided by a PPO. In the end, POSs are popular among those who want a “hybrid model” that includes some of the benefits of HMOs and PPOs.
- EPOs: Exclusive Provider Organizations only provide coverage for health care providers within the insurer network. If you need to visit a provider outside of this network, you won’t receive any coverage. Referrals are not necessary to see specialists – but you’re responsible for paying the entire bill if you do so. As long as your preferred providers are in the same network, you can enjoy lower monthly premiums compared to HMOs and PPOs.
While the above four categories give you plenty to ponder, there are many other options to consider if you choose to consider non-ACA plans. The above four options only apply to the ACA marketplace.
Here are your options if you venture outside of the ACA marketplace:
- Short-term insurance: One of the most obvious alternatives is short-term insurance. These plans are sold outside of the ACA marketplace, and they are mostly intended to fill gaps in coverage before you move on to a long-term coverage solution. However, short-term insurance is definitely not the most affordable option, as it generally involves higher costs compared to virtually any other Affordable Care Act plan. Some might have no choice but to select this option, such as those who have been fired or those who are waiting for Medicare eligibility.
- Health sharing plans: Health sharing plans are growing in popularity because of their affordability and simplicity. While health sharing or crowdfunding health care systems are not the same as health insurance, they can help average Americans pay their medical bills in a reliable manner. One of the major benefits of a health sharing plan is that there are no open enrollment periods – meaning you can sign up whenever you want. This makes health sharing plans popular among those who need gap coverage and those who are searching for long-term solutions. In addition, these plans often require no deductibles and low monthly fees compared to traditional health coverage.
- Medicare: Many people are under the impression that ACA plans and Medicare fall under the same category, but they are actually two different types of health coverage. Medicare is specifically geared towards seniors and retirees, and it is provided by the federal government instead of the federally regulated ACA marketplace. While the ACA laws regulate this marketplace, the actual plans are offered by private insurance companies. The cost of Medicare can be much lower than these private plans offered through the ACA marketplace.
- Medicaid: Medicaid is perhaps one of the most affordable options for health coverage, as this government-sponsored program is geared toward the most financially insecure Americans. If you qualify for Medicaid, there’s really no reason not to consider it. However, very few people qualify – and even those who are struggling with low incomes might earn just enough to become ineligible.
- Private health insurance: When you hear “private health insurance” being discussed in the United States, people are generally referring to plans offered outside of the ACA marketplace. While both ACA plans and non-ACA plans are technically “private,” non-ACA-compliant plans are what most people think of when they hear “private health insurance.” These insurance plans do not comply with ACA standards, and they may be cheaper as a result. These health plans can also choose not to accept those with pre-existing health conditions, thereby lowering costs for other members. Short-term health insurance is one example of a non-ACA plan that is offered outside of the federally regulated marketplace. If you choose one of these plans, you may save money but lose access to tax credits or other incentives offered by the government.
- COBRA: COBRA is another government program that guarantees workers continued coverage if they lose access to their employer’s group health plan for whatever reason. These employees might have been fired, or they may have had their hours reduced to the point where they no longer qualify for health benefits through their employers. Some become eligible for COBRA after quitting or retiring. COBRA is another example of temporary health insurance, and it may be more expensive than other alternatives. However, it allows workers to keep the exact same benefits as they previously enjoyed under their employer’s health insurance plan.
What percent do I need to pay for health coverage?
One of the best ways to assess the affordability of a health plan is to determine the percentage you’ll need to pay for your health care needs. You can do this by checking where your plan lies on the “metal tier” system:
- Bronze: Plans under the Bronze category offer the lowest monthly premiums but the highest costs when you actually need care. Under this plan, you are responsible for paying 40% of your medical fees, while the insurer pays 60%. Deductibles are also quite high, and you might have to pay thousands of dollars before you receive any coverage. Bronze plans are popular among those who feel that they have low health care needs but want protection in case of emergency.
- Silver: Plans under the Silver category offer a balance, requiring slightly higher premiums but also requiring you to pay less when you need care. Under this plan, you are responsible for paying 30% of your medical costs, while the insurer pays the remaining 30%. Silver plans also require lower deductibles compared to Bronze plans. Silver plans are unique because they offer the opportunity for cost-sharing reductions that are not available with any other category. This can potentially save you thousands each month – especially if you visit the doctor frequently.
- Gold: Plans under the Gold category require high monthly premiums, but you pay less when you need care. Under this plan, the insurer pays 80% of your medical bills while you pay the remaining 20%. Deductibles are also quite low, which makes this a good choice if you need frequent medical care.
- Platinum: Plans under the Platinum category require the highest monthly premiums, but you pay very little when you need care. Under this plan, you are required to pay just 10% of your medical bills, while the insurer pays the remaining 90%. You can also expect the lowest deductibles out of all the metal tiers. This is a solid choice if you need medical care numerous times each month, and the higher monthly premium is offset by the savings in coverage.
Note that this overall system has no effect on the quality of care you’ll receive. Someone with a Platinum plan will still get exactly the same care and attention from providers as someone with a Bronze plan.
How do I know whether a health care plan is truly affordable?
Affordability might not be as easy to assess as you think when it comes to health insurance. Most people simply consider the monthly premiums, but you also need to think about what might happen if you incur expensive unexpected medical costs.
Think about your deductibles, and factor in your annual expected costs. You might also want to think about how much care you actually need on a monthly basis. Consider your age, your general health, and any family history of disorders or diseases.
It might be helpful to ask an expert to help you choose the best option – such as an insurance broker.
Is choosing the cheapest option beneficial for my healthcare?
Choosing the cheapest possible option might not be the most beneficial decision for your overall well-being. Cheap plans may fall short when you need medical care, and you might be stuck with expensive deductibles and other out-of-pocket costs.
Always consider the bigger picture when assessing not only affordability, but also quality.
On the other hand, a cheap plan may allow you to save more each month – providing you with the opportunity to purchase more nutritious food and make other healthy lifetstyyle choices that might not have been affordable otherwise.
As always, choosing affordable health insurance and health coverage is something of a balancing act with many factors to consider.
Can CrowdHealth help with my health care needs?
If you’ve been searching for an affordable alternative to the traditional health insurance system, you might want to consider CrowdHealth.
This is not the same as health insurance, but its innovative crowdfunding system provides many of the same general benefits.
Once you become a member of CrowdHealth, you can submit your medical receipts to the platform. From there, CrowdHealth can facilitate the crowdfunding process, allowing your medical bills to be paid by other members.
CrowdHealth is affordable because there are no deductibles. In addition, the monthly fees associated with membership are much lower than the premiums for a typical, traditional health insurance plan.
If you’d like to learn more about CrowdHealth, reach out today and speak with one of our team members. We can answer all of your questions and explain how this system works in much more detail.
Get access to our entire suite of tools that effectively and affordably helps you navigate the complex health care system.
Whether you need help finding a doctor, negotiating health bills, or getting your bills crowdfunded, our team of health care experts are on your side every step of the way.
Our community helps each other pay for medical bills instead of lining insurance companies pockets. You know exactly where your money goes with CrowdHealth.
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