How to Shop for Health Insurance

are you in the market for health insurance are you unsure about how to choose the right plan for you and your family the pennsylvania insurance department is here to help first let's talk about when to buy insurance you can usually only shop for insurance during a period that occurs once a year called open enrollment during open enrollment you can buy a new plan or change the plan you have open enrollment starts in October or November and ends in December or January you can find the dates of the

next open enrollment on healthcare.gov which is the federal marketplace for health insurance once open enrollment ends you can only buy insurance if you experience a life change like losing coverage from a job moving getting married or having a baby if you do not have insurance you may have to pay a penalty to the federal government when you file your taxes the cost of a health insurance plan can change every year check if your costs are increasing and

find out if there's a better plan for you the Pennsylvania insurance department reviews changes in plan costs every year in the spring and summer you can find out more about this process and comments on proposed changes on our website so how do you know what coverage you need there are three things that you should think about the doctors a plan works with this is called the provider network the prescription drugs a plan covers and the cost you will have to pay you will pay less to see providers that

accept your health insurance this is called in-network you will pay more to see providers that do not accept your health insurance this is called out of network each insurance company publishes a list of the providers available in their plan on their website called a provider directory now let's talk about prescription drug coverage if you need a specific prescription you can check if that drug is covered under an insurance plan the list of drugs covered by a plan

is called a formulary next let's talk about the different costs you will pay for health insurance the five types of costs are premiums co-pays deductibles coinsurance and out-of-pocket limits your upfront monthly payment for insurance is called a premium this is the first price you see but it's not the only cost you may pay other costs when you receive care a deductible is the amount you pay before your insurance company pays the rest of the cost of

care most plans with low premiums have high deductibles fees do when you receive service like visiting the doctor or picking up a prescription are called co-pays coinsurance is like a copay it is a charge due at the time you get care but as a percentage of the cost instead of a set fee the out-of-pocket limit is the maximum amount of non premium costs that you will have to pay in a year including deductibles co-pays and coinsurance the Affordable Care Act made

certain preventive healthcare services free for anyone with insurance you should not be charged for these services to help you decide which combination of costs and benefits is right for you insurance companies name their plans by metal levels the metal levels are bronze silver gold and platinum this chart shows how each metal level represents how you and your plan share costs Healthcare gov is a great place to compare plans

it also has information about subsidies which may lower your premium or out-of-pocket costs many people who think they do not qualify for a subsidy actually do in 2015 a family of four with an income of $95,000 qualified for a subsidy you can only get a subsidy through healthcare.gov which will also give you information on other programs if you qualify to help you enroll in person or over the phone healthcare.gov has people called navigators you can also buy a plan

directly through a health plan website or independent insurance agent do you have everything you need here's a checklist make sure the providers and services you want are covered by the plan you are considering depending on how much you use your insurance and the monthly costs you can afford think about how you want to balance up front costs like a premium versus costs you pay at the time of care like a copay you can use the metal levels as a guide consider

shopping on the federal marketplace at healthcare.gov to make sure you don't pay a penalty always buy insurance during open enrollment happy shopping you you