Everything you need to know about health insurance, simplified
Health insurance is a contract between you and an insurance company. You pay a monthly premium, and in exchange, the insurance company helps cover your medical costs when you need care.
The Affordable Care Act (ACA) requires most Americans to have health insurance and ensures that insurance companies can't deny coverage based on pre-existing conditions.
All ACA-compliant health insurance plans must cover these 10 essential health benefits:
The amount you pay each month for your insurance coverage, regardless of whether you use healthcare services.
The amount you pay out-of-pocket for covered services before your insurance starts paying. Lower deductibles mean higher premiums.
A fixed amount you pay for covered services, like $30 for a doctor visit. Copays usually don't count toward your deductible.
Your share of costs for covered services, calculated as a percentage (like 20%) after you've met your deductible.
The most you'll pay for covered services in a year. After you reach this amount, your insurance pays 100%.
The group of doctors, hospitals, and providers that have contracts with your insurance company. Using in-network providers costs less.
Think about how often you visit doctors, what medications you take, and any upcoming procedures. If you have chronic conditions or see specialists regularly, a Gold or Platinum plan might save you money despite higher premiums.
Make sure your preferred doctors, hospitals, and specialists are in the plan's network. Going out-of-network can significantly increase your costs.
Don't just look at the monthly premium. Calculate your total annual costs by adding premiums, deductibles, copays, and coinsurance based on your expected healthcare usage.
Check if your medications are covered and which tier they're in. Some plans may require prior authorization or offer only generic versions.
Bronze plans have the lowest premiums but highest out-of-pocket costs (good for healthy people). Silver plans balance costs and benefits. Gold and Platinum plans have higher premiums but lower costs when you need care.
When: November 1 - January 15 each year
This is the main enrollment period when anyone can sign up for or change their health insurance plan for the following year.
When: Within 60 days of a qualifying life event
You can enroll outside of Open Enrollment if you experience certain life events:
Premium Tax Credits (also called subsidies) are financial assistance from the government to help lower your monthly insurance premium. Most people who buy insurance through the ACA Marketplace qualify for some level of subsidy.
Our licensed agents can help you understand your options and find the right plan.
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