Buying Healthcare Insurance

So now that you know you have to buy healthcare insurance, how do you do it?  What is cost-sharing? What is an Advanced Premium Tax Credits, and  where can you find out what it’s all going to cost and what you’re eligible for?

” The Marketplace” is the listing of approved healthcare insurance plans available in your state, and each state has its own plans and way of doing things. It’s also called your state’s ‘exchange’. In order to get tax credits for paying insurance premiums you need to buy your plan on the exchange. ‘Off-exchange” plans aren’t eligible. (Is anyone else picturing some shady guy on a street corner sidling up and reaching under his coat; ‘Hey buddy, wanna buy a plan??’ No? Ok, I’ll keep my cartoons in my head.  ;^)

The various plans offered on the state exchanges are called the “metal plans”. From lowest to highest the list is bronze, silver, gold and platinum.  The lowest (bronze) plans cost less, but they also give far less coverage, and are sometimes called ‘catastrophic coverage’. They’re good for people who are never ever sick but might need coverage in case of a snowboarding wreck or an unplanned surgery. They cover about 60% of your medical costs after a very high deductible, sometimes $6000.  Bronze costs almost as much as silver, but silver gives much better coverage, so you might find that is the best bang for your buck. Remember, no matter what plan you choose you will get preventive care and exams, in some states even a few doctor’s visits outside of preventive care. 

Cost Sharing and Tax Credits

You can only qualify for ‘cost sharing plans’ if you carry a silver plan, and not just any silver plan. You’ll have to ask the insurance company about this. Those cost sharing plans will lower your out-of-pocket costs for care if you qualify, but it pretty much only applies to people that are close to poverty level. The cost sharing plan means you have a much lower deductible and lower copays than you would otherwise, and it’s figured and handled by the insurance company, so there’s no song and dance involving the government or rebates and paperwork.

People who are eligible for Advanced Premium Tax Credits to help pay their premiums can buy any plan they want as long as it’s on the state exchange. They don’t have to choose silver. Translation: If your income is up to 4 times poverty level,  you may qualify to have part of  your insurance premiums  subsidized by the federal government. They will give you an advance based on your projected income for that year. If you make too much money, you’ll have to refund some of it.  Many states have also expanded the Medicaid program to cover single individuals, so check if you qualify for that.

Basically each state picks a “benchmark plan” to model what they are going to offer as the average, usually the second-lowest priced silver plan available on the  state health insurance exchange. Tax credit amounts are derived on the cost of that plan and are then adjusted according to an enrollee’s annual income (that’s you). Healthcare reform meme showing girl choosing between pizza and salad

For Further Information:

The premiums for plans and credits and subsidies available are completely dependent on where you live, not only by state, but by county, so once again you need to plug into your state’s system. You can get started here at healthcare.gov. Another really good and complete resource for helping you to understand all the ins and outs of the entire program is Health Reform; Beyond the Basics. It has pages and pages and webinars and all manner of stuff.

I know, this is all pretty overwhelming.  Like I said before, ask lots of questions and call multiple companies to be sure you understand exactly what you qualify for. 

Let’s face it, the only sure way to save money on medical costs is by taking good care of yourself. Do your best to use safety equipment, don’t smoke, don’t drink excessively, eat your veggies, and exercise.  Most of the chronic illnesses killing us today we’re doing to ourselves. You don’t have to be a born-again granola raw vegan paleo grass-fed fanatic, just don’t over-eat, eat less sugar, less salt, and if you can’t pronounce it or spell it don’t put it in your mouth. Unless it’s guacamole … or French … or quinoa. Just kidding… quinoa is kinda weird ….