Are you facing the prospect of buying individual health insurance for the first time?
Finding your own insurance coverage can be intimidating. Whether you’re turning 26 and facing losing coverage through your parents, or shopping for yourself because you aren’t covered through school or work, it’s important to find a plan that works for you.
But there are a lot of important factors to balance, and it can be difficult to even know where to start. Let’s see if we can set you down on the right path: let’s run down what you need to know if you’re buying health insurance for the very first time:
“When Can I Enroll?”
Many young adults lose coverage through their parents’ plans when they turn 26. If this happens to you, this counts as a Qualifying Life Event (QLE), which triggers a special enrollment period during which you can purchase health insurance.
But there are several different types of QLEs people may experience:
- Family or household changes (such as getting married or divorced, or having a child)
- Employment changes (such as losing health benefits through a job, or experiencing a significant change in income)
- Changes in residence (such as moving to a new city or state)
- Loss of coverage (due to your current plan being discontinued, for example)
Broadly speaking, experiencing a Qualifying Life Event (QLE) opens a 60-day window to shop for new insurance coverage. Some QLEs offer wider time periods. Individuals turning 26, for example, are given a 120-day window (60 days before they lose coverage, and 60 days after).
In most other cases, if you do not experience/qualify for a QLE, the best time to shop for a new individual insurance plan is during the annual Open Enrollment Period, which occurs at the end of the calendar year. During this period of time, insurance companies make all of their plans available to the public through state and federal marketplaces, so that you can enroll—or re-enroll, if you already have coverage that still matches your health needs—in a plan that works for you..
Curious about how Open Enrollment works? Check out our primer on this important annual event, available here.
“What Do I Need to Know to Compare Plans?”
There’s no denying that health insurance can be complicated. As you start to look around, you may find that there are many different coverage options out there. And as you drill down into the specifics of individual plans, you may find that there are many different terms and variables to consider, some of which you may not have seen before.
The health insurance marketplace is always changing, and there are many different factors that go into getting a plan, including your personal health needs. As you dig deeper into health insurance, there may be certain factors and phrases that you see come up again and again. Understanding these concepts is vital to understanding which specific policy or healthcare strategy will work best for you (more on that in a second).
Let’s see if we can help make some of those confusing concepts clearer. Here’s a rundown of some common terms to know as you shop for health insurance for the first time:
- Premium: The amount you pay for your health insurance every month
- Deductible: The set amount of money you’ll have to pay for healthcare services out of your own pocket within the year, before your health insurance begins to start sharing the cost
- Copayment: The flat fee you pay every time you get a medical service. Your plan may have different copayment amounts for primary care physicians, specialists, medication, etc.
- Coinsurance: the percentage of costs for a covered service that you’ll share with your insurance company, after you’ve paid your deductible
- Out-of-Pocket Maximum: The ceiling (set dollar amount) on what you must pay for yourself (aka “out-of-pocket”) for covered health services in a single year. This includes your deductible, copayments, and coinsurance.
- Health Savings Account (HSA): A special account that some plans offer to help you pay for medical expenses. You contribute pre-tax money to this account, to help cover your deductible, copayments, and other expenses. Any unused funds roll over, year-to-year.
- Network: Your health network is the group of medical professionals—including doctors, surgeons, hospitals, pharmacists, etc.—who have agreed to provide service to people who are on your health insurance policy.
“How Can I Tell What Kind of Coverage I Need?”
Now, with all of those variables in mind, it’s time to start thinking about finding the health insurance plan that will work best for you.
Ultimately, there is no universal “perfect” plan; the right plan for each person will be different. Just as no two people are exactly alike, health insurance shouldn’t be thought of as cookie-cutter, or “one size fits all.”
So, what goes into determining the right plan for you? You’ll want to weigh factors like:
The amount of healthcare attention you’ll need
For instance, if you’re relatively healthy and only visit the doctor a few times per year, you may want to opt for a higher-deductible plan, which may offer a lower premium and access to an HSA. If you need more regular treatment, you may look for a plan with a lower deductible, as this could help keep your costs lower in the long run. In other cases, you may want to add riders for dental care or accident coverage, depending on your preferences. Everyone’s healthcare wants and needs will be different.
How much are you willing to pay for health insurance? There are many different plans out there, offering different levels of coverage at different price points. It’s important to find the right balance between your out-of-pocket costs, your deductible, and your coverage level. Do you prefer to have a lower monthly premium or a lower deductible? Flat copays for visits to the doctor, or a more variable coinsurance percentage?
Which healthcare providers you want to see
Do you have a favorite family doctor that you’ve been seeing for decades? Is there a type of specialized medical care you know that you require? It’s important to take healthcare networks into consideration as you compare plans. Is it worth finding a plan that has your current medical “team” in-network, or are you OK with maybe finding new doctors? Similarly, would you prefer to have to see a primary care physician in order to get a referral to a specialist, or do you want greater flexibility? Again, everyone’s experience will be unique, but these are important questions to ask yourself.
“Do I Have To Do All This Alone?”
There’s a lot to get a handle on when it comes to health insurance. Finding the right time to enroll, figuring out how to enroll, determining the plan options that will best suit your needs—all of this can be a lot to take on alone.
This is where a health insurance broker, like Matt Peebles, can help you. With Matt and the Enrollment Specialists team in your corner, you don’t have to face the ever-changing world of health insurance all by yourself. They can help make finding the right plan for you simple—and all at absolutely no cost to you.
Think of Matt as your personal health insurance consultant. When you get in touch, this health insurance superhero will jump into action. He’ll sit down with you and determine what makes your situation unique. From there, he’ll help customize a health insurance plan that ensures that your costs are minimized, while your coverage is at its peak. He’ll take on any questions you have, and make sure that you fully understand your policy options at every step of the way.
For you, this means no guesswork, no intimidating health insurance company websites, and no hours of poring over the small print. Matt makes finding the right health insurance policy easy, so you can get back to the most important things in life, knowing that you’re covered.
Matt is one of the leading health insurance brokers in the country, with unparalleled experience and connections to help you get what you truly need.
Even better? Matt will be your go-to guy for all things health insurance, for the entire life of your policy. Whenever you:
- Have questions about your policy
- Need some quick advice
- Require new insurance cards
- Want a go-between to work with your insurance company on your behalf
- Are curious about changes in health insurance laws or regulations
- Need an advocate on your side
Matt will always be just a quick email or phone call away. He’ll be there to help whenever you need him, so you won’t have to deal with frustrating call centers or faceless “customer service” chatrooms.
Matt is a proven leader in providing the right healthcare solutions for individuals, businesses, and families, and has gotten results for hundreds of clients all across the country.
Ready to take control of your healthcare future? Want to be able to confidently say, “I Got A Guy” for all things health insurance? Drop us a line today to get the conversation started, and see what Matt and the rest of the Enrollment Specialists can do for you.