The Health Insurance Open Enrollment Period is coming up: starting November 1st, you’ll have around 6 weeks to find a plan that meets your needs. That means a lot of information about all the different health insurance plans available, and information about any changes to your current plan will soon be coming your way. You’ll have to sort through all of this while trying to figure out how much coverage you need, and what you can afford, which can feel like a lot. And this time is going to come and go quickly! That means it’s important to begin planning now, so you are ready and don’t feel rushed during the process.
Luckily, you won’t have to feel alone during this OEP, because EZ.Insure is here to help! EZ.Insure makes the enrollment process stress-free and simple. Our easy-to-use platform provides free quotes and side-by-side comparisons of all the available health plans in your area. We also have a team of dedicated agents who are always on hand to help guide you through the process or answer any questions, so you can leave feeling confident in your coverage. To help you feel even more prepared, we’ve compiled a brief list of helpful tips so you can tackle this OEP with ease.
EZ’s certified insurance agents are also always up-to-date on the newest healthcare plans.
1. Choose an Unbiased Agent
Who you choose to work with when looking for a health insurance plan is a very important decision, and plays a big part in finding a comprehensive, affordable plan. It’s important to work with a licensed, knowledgeable agent who is not connected to a certain type of health insurance plan or insurance company, so you can get an unbiased look at all available options in your area.
EZ’s agents work with the top-rated health insurance companies in the nation, and we guarantee that we will compare all plans in your area so that you can find the perfect plan. And not only are our agents independent, but they are also always up-to-date on newer healthcare plans, so they can provide you with all the information that you need before you make your decision.
2. Consider ALL of Your Options
After choosing to work with an EZ agent, you can simply ask them to research every option that you have, as well as help you weigh all the pros and cons of each plan. There are many different types of healthcare plans available, including PPO plans, HMO plans, or metal tier plans; if you’re not sure what’s best for you, an EZ agent will go over all of these different plan types, and will not try to limit you to a certain plan. We will lay all of your options on the table and review the coverage and cost of each one.
3. Ask the Right Questions
When it’s time to start searching for plans, think ahead of time about what you want to ask your agent, and what is important to you in a plan. In addition to asking about prices and coverage options, have a list of questions you want to ask, like:
Is mental health care (or anything else you’re interested in having covered) covered?
Is a higher deductible or lower premium plan better for you?
4. Find the Plan That Has the Most Value
People often choose the cheapest plan available, but this cheapest plan might not have the best benefits available for the price. A good health insurance plan will come from a quality carrier, provide comprehensive benefits, allow you to see the doctors you want to see, and have affordable co-pays. And remember, if you go for the cheapest plan available, you might end up paying more out-of-pocket when you use medical services. Our agent will review your medical needs and budget, and search for a plan that will check all the boxes for you.
Need Help? EZ’s Got You Covered
The health insurance Open Enrollment Period will be open from November 1st through January 15 (depending on your state), so now is the perfect time to reconsider getting a health insurance plan, or to look closely at your current one to make sure it will cover all of the above-mentioned costs. And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible.
If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan meets your financial needs. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890. No obligation.
Health insurance is an important component of financial and physical well-being since it allows people to obtain necessary medical care. However, not everyone chooses the health insurance provided by their employment or through government programs. Some people choose to look for alternatives, and one way to do this is to get a health insurance waiver. A health insurance waiver form will typically include information about your request to forgo access to a health insurance plan that has been made available to you.
Waiving Employer-Sponsored Health Plans
Company-sponsored health insurance plans can be a considerable advantage for employees. Especially when the company pays for all or a portion of the employee’s health insurance benefit. However, it is possible that a person will not require the medical coverage supplied by their work. Employees are not compelled to partake in perks such as health insurance, which is the best part. There is no penalty for refusing coverage.
When an employee does not want their employer’s health insurance, they waive coverage. Employees can also forgo coverage for a family member who was previously covered under their plan. Employees can only opt out of coverage during specific time periods. Here are some examples of when employees can choose to forego coverage:
When they first start their job and are initially offered coverage.
During an open enrollment period, which takes place once a year and lets employees enroll, change, or opt out of coverage.
If the company begins to offer a new plan.
If someone has a change to their family such as a marriage, divorce, or birth. This qualifies them for a Special Enrollment Period.
The health insurance waiver is frequently considered as an employee perk since some firms offer to reimburse the employee for the financial value of the cost of insurance by waiving insurance. However, because most employers do not cover the entire cost of coverage, there is less of an incentive to avoid providing those benefits.
Keep In Mind
Signing a health insurance waiver may no longer provide any advantage in terms of employee perks in the form of a wage “increase” because many firms no longer pay for their workers’ health insurance benefits as they used to. However, because you will be covered via an alternate plan rather than the employer plan, the waiver may still reduce the costs of payroll deductions for your insurance.
Waiving College or University Health Plans
Universities frequently offer health insurance waivers. Students who are already enrolled in comparable or better health insurance plans than those given by their college or university typically have the option of waiving the health insurance by completing a health insurance waiver form and presenting proof of comparable coverage elsewhere. The submission deadlines for these waivers correlate to school terms. This is a common choice for students because they are frequently covered by a family plan, and the cost savings from foregoing health insurance can amount to thousands of dollars each year.
Proof Requirement
You may also be required to give proof of the reason you seek to forgo health insurance coverage, depending on the organization or reason for your request. This is for the organization, business, or school that is providing you with the plan’s protection.
Before processing your health insurance waiver request, the organization may wish to confirm that you have adequate health insurance elsewhere. Health insurance waivers may need to be signed on an annual basis, and if your circumstances change, you may be required to notify your plan provider.
Why People Use A Health Insurance Waiver
There are numerous reasons why you might decide to forego your health insurance coverage, but before you do, consider the benefits of dual coverage or benefit coordination. If you have a lot of medical bills or specific needs, it may be more beneficial to use multiple plans. Always consider all of your alternatives. For example, you may wish to waive coverage if your employer’s or student’s health insurance plan is not necessary because you already have coverage via another plan. Other circumstances in which you may obtain a health insurance waiver include:
Spousal Coverage – Individuals who are qualified for health insurance through their spouse’s employer may choose to forego their own coverage in favor of the spousal plan. This choice may be influenced by factors including cost, coverage options, or personal preferences.
Government Programs – Individuals may be eligible for government-sponsored health insurance programs, but choose to forego coverage in specific instances. This could be because of a desire for private insurance, unhappiness with the government plan, or specific coverage needs that the public program does not meet.
Alternative Options – Some people may have access to other insurance options, such as individual or family plans, and opt out of employer-provided coverage in favor of these options. Cost, coverage scope, and network preferences may all have an impact on the selection.
Coverage Preferences – Individuals might have specific preferences regarding healthcare providers, networks, or types of coverage. Opting for a waiver allows them the freedom to choose a plan that aligns better with their preferences and needs.
Alternative Health Insurance Options
If you decide to pass on health insurance offered by your job or school and choose to buy individual health insurance it’s important to know your options. There are several types of plans that all cover care in different ways. So it’s easy to find a plan that fits exactly what you need.
Health Maintenance Organizations (HMO)
HMOs offer you the option of choosing from a local network of participating physicians, hospitals, and other healthcare providers and facilities. As part of these health insurance policies, you must choose a primary care physician (PCP) from this network. Your primary care physician (PCP) will get to know you and help you organize all of your medical care. They are also responsible for referring you to any specialists; without this recommendation, your HMO would not cover a specialist visit. Out-of-pocket payments for an HMO plan are frequently lower than those for other types of health plans as long as you stay in-network.
PPOs offer very vast networks of participating providers. So, you can choose from a wide range of hospitals, clinics, and other healthcare facilities and experts. Unlike HMOs, PPOs provide some coverage for providers outside of their network,. But not as much as they would for an in-network provider. Another significant distinction between PPOs and HMOs is that you are not compelled to select a PCP and can see a specialist without a referral.
EPOs also provide you with access to a network of participating providers from which you can choose. The majority of EPO plans, with the exception of emergencies, do not cover care received outside of their network. As a result, if you visit a provider or facility that is not part of the plan’s local network, you will most likely be responsible for the full cost of services. You may or may not be needed to select a PCP depending on the plan. In either case, you will not need a recommendation from a PCP to see a specialist. As long as they are in the network of the plan.
PPOs and HMOs are combined in POS plans. A POS plan’s provider network, like that of an HMO, is often smaller than that of a PPO plan. And in-network care expenses are typically lower, as with a PPO. In POS plans, you must choose a primary care provider (PCP) from a network of physicians and other primary care specialists.
If you need to see a specialist, you must acquire a referral from a POS. However, like with PPO, you can choose to see in-network or out-of-network experts. However, if you visit an out-of-network provider, your part of the costs will be higher. And you will be responsible for submitting any claims if you visit a physician who is not in the plan’s network.
An HRA, or health reimbursement arrangement, is a form of health expenditure account provided and owned by the employer. Because they own the HRA, your employer is the only one who can contribute to it. They can also determine if you can roll over unused cash into the next year. The money in it is used to pay for eligible expenses. Including medical, pharmaceutical, dental, vision care, and as defined by the employer.
The Bottom Line
Health insurance waivers give people the freedom to choose how they want to be covered for medical care based on their own needs and circumstances. Even though they give people some freedom. People who decide to not have coverage should carefully think about the risks and other options. In turn, employers and schools have to deal with the paperwork side of health insurance waivers. Making sure they follow the law and encourage open communication. The use of health insurance waivers is still a moving part of the larger conversation about healthcare access and personal freedom, even as healthcare changes.
There are numerous sorts of health insurance plans to choose from. So it all comes down to you: your requirements, your budget, and your overall health. When looking for the best plan, the greatest thing you can do is compare the features of various plans. As a result, you can obtain the most coverage for the least money. Even if you are normally healthy, health insurance is a vital component of life. You never know what can happen, and it’s always better to be cautious than sorry. To begin, enter your zip code into the box below or call one of our qualified representatives at 877-670-3557.
If you want your new health insurance to start on January 1st then you must enroll before December 15th. You can still enroll until January 15th, but your policy won’t start until February. We know you’ve been hearing OEP over and over the last few months, but that’s because we can’t stress enough how important it is. Not only is this the only time you can enroll in a new plan. This is the only time you can review your current plan and make sure you have all of the coverage you need within your budget. You’re in control of your health and there’s plenty of plan and carrier options out there ready to help you stay in control.
Guaranteed Coverages
The Affordable Care Act (ACA) brought a lot of change to the health insurance industry. All of which center around making sure everyone has access to affordable coverage. The ACA introduced the “10 essential benefits”. Which are 10 health care benefits that every marketplace plan must cover regardless of tier, plan type, cost, or provider.
Ambulatory patient services
Emergency services
Hospitalization
Laboratory services
Mental health and substance use services
Pregnancy, maternity, and newborn care
Prescription medications
Preventative and wellness services and chronic disease management
Pediatric services
Rehabilitative and habilitative services
Not only are health plans required to cover these benefits. Insurers are also prohibited from denying or charging more for a plan based on pre-existing conditions. So thanks to the ACA you are guaranteed to get a plan that covers all of your basic needs without having to pay an arm and a leg.
Your Options
You’ve got nothing but options during the OEP, from plans to plan tiers to possible subsidies and then some. Let’s go over the basics and give you a good starting point in your search.
The first thing you have to do is choose a plan type. While every Marketplace plan is legally required to cover the “10 essential benefits”. Plans can offer extra benefits and they can all be structured differently. So, this step is a big one because it sets the foundation for the coverage you have.
HMOs offer you the option of choosing from a local network of participating physicians, hospitals, and other healthcare providers and facilities. As part of these health insurance policies, you must choose a primary care physician (PCP) from this network. Your primary care physician (PCP) will get to know you and help you organize all of your medical care. They are also responsible for referring you to any specialists. Without this recommendation, your HMO would not cover a specialist visit. A HMO plan’s out-of-pocket costs are frequently lower than those of other types of health plans as long as you stay in-network. In general, an HMO may make sense if you prioritize lower expenses and don’t mind using a PCP to oversee your treatment.
PPOs offer a vast network of participating providers, so you can choose from a wide range of hospitals, clinics, and healthcare facilities. Unlike HMOs, PPOs provide some coverage for providers outside of their network, but not as much as they would for an in-network provider. Another significant distinction between PPOs and HMOs is that you aren’t required to choose a PCP and you can see a specialist without a referral. A PPO is often a smart option if you want more control over your options and are willing to pay extra for it. It would be especially useful if you travel frequently because you would not have to see a primary care physician.
Exclusive Provider Organization (EPO)
EPOs also allow you to choose from a network of participating providers. Except in cases of emergency, most EPO plans do not cover care outside of their network. As a result, if you see a provider or facility that is not part of the plan’s local network, you will most likely be paying for the whole cost of services. As for PCPs, EPOs can go either way, some require you to choose a PCP and others don’t, it just depends on the insurance company you choose. In either case, as long as the specialist is in the plan’s network, you will not require a referral from your primary care physician. If you need cheaper monthly rates and are ready to pay a larger deductible when you need medical treatment, an EPO plan may be for you.
Point of Service (POS)
POS plans combine the benefits of PPOs and HMOs. A POS’s provider network, like an HMO, is often smaller than a PPO plan, and in-network care expenses are typically lower, as with a PPO. In POS plans, you must select a primary care provider (PCP) from a network of physicians and other primary care specialists. If you need to see a specialist, you have to get a referral from your PCP.
However, just like with PPO, you have the option of seeing in-network or out-of-network experts. However, if you visit an out-of-network provider, your part of the costs will be higher, and you will be responsible for submitting any claims. POS insurance plans are a terrific option for many people, especially if you’re looking to save money and don’t need out-of-network healthcare services. If you are prepared to coordinate your care through a primary care physician, a POS plan may be perfect for you.
Health Expense Accounts
There are also separate savings plans you can buy to help you save up money specifically for medical costs.
An HRA, or health reimbursement arrangement, is a form of health expense account provided and owned by your employer. Because they own the HRA, your employer is the only one who can contribute to it. They can also determine if you can roll over unused cash to the next year. The money in it is used to pay for eligible expenses including medical, pharmaceutical, dental, and vision care, as defined by the employer.
A health savings account (HSA) is a bank account that you can use to pay for qualifying health care bills or to save for retirement. An HSA is available when combined with a qualified high-deductible health plan (HDHP), which has lower premiums/plan contributions and greater deductibles than a regular health plan. If you have an employer-sponsored health plan, the account is opened through the HSA provider chosen by your company. You, your employer, and others can contribute to your HSA up to a yearly limit determined by the IRS.
Flexible Spending Account (FSA)
An FSA is an employer-sponsored savings account that helps manage out-of-pocket healthcare bills. FSAs are tax-advantaged accounts, which means you can contribute to them before taxes and spend the money tax-free. FSAs allow account holders to save for eligible healthcare expenses by deducting pre-tax money directly from their paychecks. FSA funds can be used to cover deductibles, co-pays, and medical visits for you, your spouse, and any qualified dependents. Employers may contribute to their employees’ FSAs, but they are not obligated to do so.
Health Insurance Subsidies
Marketplace plans have two types of subsidy. The first type, known as the premium tax credit, lowers your monthly insurance costs. The cost sharing reduction (CSR) is a sort of financial aid that reduces your deductibles and other out-of-pocket payments when you visit the doctor or stay in the hospital. To get either sort of financial aid, you must enroll in a health insurance Marketplace plan.
Premium Tax Credit
A premium tax credit, sometimes known as a premium subsidy, is a tax credit that reduces or eliminates the amount of money that you would otherwise have to pay for getting individual or family health insurance. Unlike other tax credits, the premium tax credit can (and typically is) given upfront and all year. Each month, the IRS gives money to your health insurer, so you don’t have to pay as much yourself. Your tax return is then compared with the premium tax credit the following spring. You can also choose to pay full price for a health plan in your state’s exchange and then get the full premium tax credit on your tax return. Few people do this, however, because the cost of coverage without the advance premium tax credit is often out of reach for those who do qualify for the premium tax credit.
You must apply for coverage through the Marketplace and give information about your age, residence, household size, citizenship status, and expected income for the following year in order to receive the premium tax credit. Following the submission of the application, you will receive a decision indicating the amount of premium tax credit you qualify for. You can then choose to have the tax credit paid in advance, claim it later when filing your tax return, or a combination of the two.
Who’s Eligible?
To be eligible for the premium tax credit beginning in 2024, you must meet the following requirements:
Have a household income of at least the Federal Poverty Level (FPL), which is $14,580 in 2024.
Lack of affordable coverage through a workplace (including a family member’s employer)
Not be eligible for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
Have U.S. citizenship or proof of legal residency (Lawfully present immigrants with household incomes less than 100 percent FPL may also be eligible for tax subsidies through the Marketplace if all other eligibility standards are met).
If you’re married you must file your taxes jointly.
Cost Sharing Reduction
Cost sharing reductions are the second type of financial aid available. When you utilize covered health care services, cost sharing reductions reduce your out-of-pocket costs related to deductibles, copayments, and coinsurance. Cost sharing reductions are available to anyone who qualifies for a premium tax credit and has household incomes ranging from 100 to 250 percent of the poverty line. Cost sharing reductions (CSR) are only available through silver plans, as opposed to the premium tax credit, which can be applied to any metal level of coverage. CSRs are applied to a silver plan for qualified individuals, basically making deductibles and other cost sharing more comparable to that of a gold or platinum plan. Individuals earning between 100 and 250 percent of the FPL can use their premium tax credit to any metal level plan, but they can only receive cost sharing subsidies if they choose a silver-level plan.
Health Plan Tiers
When you buy health insurance through the federal or state Marketplace, the plans available are divided into four metal tiers: bronze, silver, gold, and platinum. The metal tiers allude to the portion of your medical treatment that each tier will cover, not the quality of care you will receive with one of these plans. Which plan tier you pick determines the amount of the bill you pay. The higher the coverage, the higher the cost, but the less you will have to pay out of pocket.
Bronze plans will cover 60% of costs; you will pay 40%
Silver plans will cover 70% of costs; you will pay 30%
Gold plans will cover 80% of costs; you will pay 20%
Platinum plans will cover 90% of costs; you will pay 10%
Why You Need Health Insurance
The most important advantage of having health insurance is having access to the care you need. Health insurance provides you with access to a vast network of doctors, specialists, hospitals, and laboratories. This network collaborates with you and with one another to assist you in focusing on prevention and wellness. In fact, the majority of healthcare plans provide free preventative services, such as immunizations and testing. To help you stay healthy and avoid illnesses and their consequences.
Furthermore, the Affordable Care Act requires Marketplace plans to cover pre-existing diseases. This means that even if you have a pre-existing condition, you can receive care without being rejected coverage or charged extra because of it. Because you’ll have regular access to the doctors and experts you need, your healthcare plan will also help you manage your care for any chronic illnesses you’re living with.
Your health insurance covers all of the greatest strategies to maintain your health. Having access to this type of continuous care can essentially lead to a longer and better quality of life. According to the National Library of Medicine, persons between the ages of 17 and 64 who did not have health insurance had a 40% higher mortality risk than those who did!
How EZ Can Help
Working with an agent saves you time and stress because you won’t have to decipher legal language or read fine text. Agents handle all of the legwork. So, you may rest assured that your coverage will best match your financial and medical requirements. Not to mention, EZ agents can save you hundreds of dollars on your health insurance premiums each year. We accomplish this by scouring the market for the most affordable plans, both on and off the market. In addition to locating and utilizing any available savings.
We don’t only assist you in finding a plan, we also assist you in keeping it up to date. When the time comes, we are also here to help you in filing claims with your insurance company and renewing your policy. To begin, enter your zip code in the box below. Alternatively, contact 877-670-3557 to speak with one of our licensed agents.
Health insurance can be confusing. With all the terms like deductibles, premiums, copayments, and coinsurance, some of which people often mistake for each. Those last two – copayments (or copays) and coinsurance – can be particularly problematic when it comes to confusion. Not only that, but many people are not sure when they will be required to pay them, or how they add to their out-of-pocket costs. But simply being aware of the difference between the two, and knowing how they work in your plan, can save time and energy. As well as money that would otherwise be wasted.
What Are Copays?
A copay is a predetermined amount of money you must pay when you use a medical service at the point of service. Health insurance policies typically specify copayment amounts in advance, and the amount will be different for each type of service. Examples of services that might require copayments include visits to your primary care physician, appointments with a specialist, prescriptions drugs, and emergency room visits. You might, for instance, have to pay $20 each time you see your primary care physician.
After you pay your copayment for a covered service, the insurance company will often pay for the rest. Especially for preventive care. For example, your annual check-up is a service your plan covers. So, you will only be responsible for your copay in this case. You should always check your plan’s benefits summary for specifics. But in general, copays are not included in the calculation of your maximum out-of-pocket costs.
What Is Coinsurance?
Most health insurance plans require that you pay coinsurance, or a percentage of the cost of care. With most plans, you’ll first have to meet your annual deductible. Then your insurance company will begin to cover your care, but you will have to split the cost. Your coinsurance share will depend on your plan, but you might have to pay 20% of each bill, for example.
In addition, the coinsurance percentage you’ll have to pay may vary depending on the type of medical treatment you receive. For example, you might have to pay a different amount of coinsurance for things like office visits, tests, and medications.
And, if you have a preferred provider organization (PPO) plan, you’ll most likely have to pay different amounts of coinsurance. Depending on whether or not the healthcare provider you see is in your plan’s network. For example, coinsurance for a primary care physician in your network could be 20%, while coinsurance for a primary care physician outside of your network could be 75%. That means you can lower your out-of-pocket expenses by trying to get care from in-network providers whenever possible.
How Much Should You Expect to Pay in Coinsurance?
You won’t know exactly how much you’ll end up paying in coinsurance each year, but you can estimate your out-of-pocket costs by thinking about how much care you anticipate needing. The coinsurance you pay on that care will be a chunk of your out-of-pocket expenses, in addition to your monthly premium and your annual deductible.
Your share of your medical costs will be determined by the type of plan you choose. You can choose from Bronze, Silver, Gold, or Platinum plans, each of which will require that you pay a different percentage of your medical costs:
Bronze – 40/60, You pay 40% while your insurer pays the remaining 60%
Silver – 30/70, 30% is your responsibility while your insurer pays 70%
Gold – 20/80, you pay 20% and your insurer covers 80%
Platinum – 10/90, your insurer pays 90% while you cover only 10%
How Copayments and Copays Work
As pointed out above, a copay is a predetermined amount that you have to pay for a covered service at the point of service, but coinsurance is the percentage of the total bill that you are responsible for. Both are some of the out-of-pocket costs of health insurance, but they function very differently. The difference between a copay and coinsurance can be broken down as follows:
Copayments are a set price you pay for services. You are responsible for the copays before and after you’ve met your deductible
Coinsurance is a percentage of your medical bills you have. Coinsurance is only charged after you’ve met your deductible for the year.
What this means is that a $20 copay will always be $20. But your 20% coinsurance fee will vary with the price of the service. And these costs, as always, will vary depending on the plan you choose. In general, though, your copayments and coinsurance will be lower if you choose a plan with higher premiums.
Copay and Coinsurance Example
To make things a little clearer, here’s a further example of how copays and coinsurance work: Let’s say your health insurance plan has a $3,000 deductible, $50 copays for specialists, 80/20 coinsurance, and a $6,000 out-of-pocket maximum on an individual plan (and you have no dependents covered by your plan). This $6,000 maximum means that once you pay that amount in covered medical expenses in a given year, your insurance company will begin to cover everything, and you will no longer have to pay coinsurance.
Now let’s say you go in for your free annual checkup (a preventative service) and bring up the fact that your shoulder has been bothering you lately. Your primary care physician refers you to an orthopedic surgeon for further evaluation. When you see this specialist, you will pay your $50 copay at the point of service.
The consulted specialist suggests an MRI to evaluate your shoulder pain. The price of the MRI is $1,500, and since you haven’t met your deductible for the year, you will have to pay the whole bill for this test. The MRI finds that you have torn your rotator cuff and will require surgery to repair it. The price tag for this operation is $7,000. After spending $1,500 on the MRI, you will have to pay $1,500 more in order to meet your $3,000 deductible before your insurance will cover any of the surgical costs. That leaves $5,500 to pay for the surgery, and since you have an 80/20 plan, your 20% coinsurance payment would be $1,100.
With meeting your deductible and paying your coinsurance and copayment, the total cost of repairing your torn rotator cuff would be $4,150. But remember, in this scenario, your plan has a $6,000 out-of-pocket maximum, which you would be close to meeting after this surgery.
What Should You Look for in a Plan?
Since everyone’s financial situations and requirements for health insurance vary, there is no one plan that will work for everyone. But when shopping for a plan, there are some considerations that can help narrow down your options.
For example, if you’re looking at a plan with lower monthly premiums, you’re most likely going to have a higher coinsurance percentage. Take two health care plans with different monthly premiums of $200 and $450 as an illustration. These two plans may have 30% and 20% coinsurance for ER visits, respectively. So, when looking at plans with lower premiums, you should always consider that your out-of-pocket expenses, including your coinsurance payments, might be higher.
And when it comes to the copayments included in the plans that you are looking at, keep in mind that copayments are typically not applied toward meeting deductibles. You should look into plans with lower copays if you anticipate spending a lot of money on prescription drugs. Or making multiple trips to the doctor each year.
In-Network vs Out-Of-Network
As mentioned above, some plans have different deductibles, copayments, and maximum out-of-pocket expenses if you see an in-network healthcare provider than if you see out-of-network providers. This is because doctors and hospitals that are part of your plan’s network have agreed to provide you with care at reduced costs.
These reduced costs mean that it’s important to seek care from a provider who is part of your insurance’s network if at all possible. And when looking at plans, make sure your preferred doctors and hospitals are included in the plan’s network. If you find that you are frequently seeing out-of-network providers with the plan you have. You might want to make a change to your plan during the next Open Enrollment Period. Speak to an EZ agent about your options.
FAQs
Does coinsurance apply before I meet my deductible?
No, it doesn’t. If you have a 20% coinsurance, they will only begin to cover their 80% after you’ve met your deductible.
Do all health insurance plans have copays and coinsurance?
No. You may not be required to pay a copayment for certain medical services with some plans. These plans, however, typically have higher monthly premiums. And there are also catastrophic health plans, for example, with very high deductibles and no coinsurance at all.
Are copays and coinsurance tax deductible?
If your out-of-pocket medical expenses exceed 7.5% of your AGI, you may be able to claim a tax deduction for all of your medical expenses. Including your copays and coinsurance. The excess of your healthcare costs over 7.5% of your adjusted gross income is tax deductible.
Do copayments and coinsurance count toward out-of-pocket maximums?
Your out-of-pocket maximum includes not only your deductible, but also any copays or coinsurance payments you may have made. Your regular premium payments don’t count toward your maximum.
Is it better to have a higher or lower coinsurance percentage included in your plan?
A lower coinsurance percentage means you’ll have to pay less out-of-pocket for covered medical services. But if you have a lower coinsurance percentage, you might have a higher deductible and premiums.
Conclusion
When you are searching for a health insurance plan, the plan descriptions will always include the premiums (the amount you pay on a monthly basis to maintain the plan), deductibles, copays, coinsurance, and out-of-pocket maximums. Pay close attention to all of these costs, not just the plan’s premiums. So you can get a feel for the true amount you’ll be paying for your healthcare.
If you are generally healthy, a cheaper plan that has higher deductibles could work for you. However, if you expect to have significant healthcare costs, it may be worth it to pay higher monthly premiums for a plan that will cover more of those costs.
EZ Can Help
If you need help finding the right plan for you, EZ.Insure is here to help. We can quickly evaluate all of the health insurance plans in your area. Your personal agent will help you sort through the various plans available to you. And explain all of the costs that come with each one. And the best part is that all of our services are completely free! To get your free quotes, simply enter your zip code in the box below, or give us a call at 877-670-3557.
On average, nearly 20 people are physically abused by an intimate partner every minute in the United States. This equates to almost 10 million people each year suffering domestic abuse. The sad reality is that many people in this situation feel like there’s no way out. And feel that they can’t manage alone or start fresh because their partner controls every part of their lives. But it is possible to seek help and start a new life, despite the incredible stress of taking that step forward.
If you’re worried about starting over, it might be helpful to know that you can enroll in a health insurance plan when leaving a domestic abuse situation. Meaning you’ll have one less thing to stress about.
A Special Enrollment Period (SEP) is a 60-day window when people can sign up for new health insurance coverage (or change existing coverage) outside of the annual Open Enrollment Period (OEP). Various situations (known as qualifying life events) can trigger a SEP, including leaving a domestic violence situation.
Since 2015, victims of domestic violence and spousal abandonment can apply for health insurance at any point during the year. Not only that, but they will face fewer restrictions than they would with a regular Special Enrollment Period. This SEP is available to both men and women and does not require documentation.
Several forms of domestic abuse qualify for a Special Enrollment Period.
How do you qualify for this SEP? According to the Centers for Medicare and Medicaid Services (CMS), experiencing any of the following will open up a Special Enrollment Period:
Physical abuse
Psychological abuse
Sexual abuse
Emotional abuse, including efforts by the perpetrator to control, isolate, humiliate, intimidate, or undermine your ability to reason independently
Spousal abandonment, which means you are unable to locate your spouse after trying diligently and “taking all facts and circumstances into account”
Need Help?
If you are a victim of domestic violence or abuse, call the National Domestic Violence Hotline at 800-799-7233. And if you are looking to find your own health insurance plan, call the healthcare.gov call center hotline at (800) 318-2596. Tell the representative about your domestic violence or spousal abandonment situation, so you can qualify for a Special Enrollment Period. After you are granted a SEP, you have 60 days to enroll in a plan. Once you’re ready to take that step and look for a plan of your own, come to EZ.Insure. We offer a wide range of health insurance plans from top-rated insurance companies in every state. And because we work with so many companies, and can offer all of the plans available in your area. We can find you a plan that saves you a lot of money – even hundreds of dollars – even if you don’t qualify for a subsidy. There is no obligation, or hassle, just free quotes on all available plans in your area. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.
There’s no doubt that our country has been deeply affected by the pandemic, physically, mentally, and financially. It has opened the eyes of many Americans as to how important health insurance is. And now that the health insurance Open Enrollment Period (OEP) is finally here, it’s time to focus on your health and find a great affordable plan that meets your needs while saving you some money. Before you know it, the OEP will be over, so consider the following tips to help maximize your benefits post-Covid.
Health Insurance Options
The first thing you should do now that the Open Enrollment Period is here is think about your current healthcare expenses, including premiums, deductibles, and any other out-of-pocket costs. If your current plan isn’t working for you financially, try:
Looking at all of your available health insurance plan options. If the type of plan you have isn’t working for you, look at another type, like metal tier plans, HMOs, PPOs, or any other plans that are available in your region. Comparing plans and their coverage options is the best way to ensure that you find a plan that will provide you with the best coverage without costing you an arm and a leg.
Health Savings Accounts
The next thing you should do is look into ways that you can save with plan add-ons. For example, one thing that has been overlooked by many people, but is now making a comeback thanks to the pandemic, is the health savings account (HSA). These accounts, which are only available with high-deductible health plans (HDHP), will help with healthcare costs by allowing you to save up money in a tax-advantaged account to use for medical expenses.
You can use your pre-tax money to cover any out-of-pocket expenses, including prescription drugs and doctor visits. Any contribution that you add to this health savings account will grow on a tax-free basis, and any money that you do not use will be rolled over to the following year.
Wellness Resources
And speaking of extras, the final thing you should do is take advantage of any wellness resources that are available to you through your workplace post-pandemic. These wellness resources are programs that are offered by your employer that can help you in a variety of ways, with things like financial coaching, stress management classes, tuition assistance, tutoring services, mental health counseling, gym memberships, and more.
Taking advantage of these wellness resources could help improve your health and wellbeing, which could in turn help get you better health insurance rates, especially if your health improves because of them. Not only that, but they can help you with your finances, which is important for so many of us post-pandemic.
Find Great Insurance
One of the most important things you can do for yourself and your family is getting a comprehensive health insurance plan that will allow you to get the preventive care and treatments you need. EZ.Insure can help you find a great plan that will save you money on your doctor visits, medications, and monthly premiums. Because our agents work with the top-rated insurance companies in the nation, we can search through all the available plans in your area and find the right one for you. And all of our services are free of charge! No hassle or obligation. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.
