The ACA has helped everyone have access to higher quality insurance and has expanded coverage to millions of people that didn’t have it before.
There’s no doubt about it, health insurance can be confusing. It’s important to know some of the basics so you can better understand your new insurance coverage.
A few terms to consider before you decide your medical insurance coverage for you and/or family for the year.
►Deductible: The amount of money that you may need to pay out-of-pocket for health care services before your health insurance plan begins to help with payments. For example, if your deductible is $100, your plan won’t pay for anything until you’ve paid the $100 deductible.
► Co-insurance: Your share of the health care service cost once you’ve met your deductible. Common share for health care services are 80/20, 70/30, 60/40. An 80/20 means the carrier will pay 80% and you 20% of the health care service cost. For example, if your bill is $1,000, and your co-insurance is 20%, you will pay $200 for your medical services if you have already met your deductible.
► Out-of-pocket maximum: The most you’ll pay in a policy period (usually one year), before your plan starts to pay 100% of the covered Essential Health Benefits you receive. This limit must include Deductibles, Coinsurance, and Co-payments, but does not typically count Premiums, toward your out of pocket maximum.
Examples if you want a Do It Yourself (DIY) Quote.
Basically you put the number of persons who you declare in your Income Tax return (form 1040).
Family of 4 Scenarios
If All 4 need insurance
► Input your zip code and the ages of all 4 and get quote.
If only You and Spouse need insurance and not the kids (since they get CHIP or other insurance).
► Input your zip code and the ages of all 4. When asked who needs coverage make sure you only select your spouse and you.
If only you and your kids need insurance, since your spouse has medical insurance at work for free or inexpensive.
► Input your zip code and the ages of all 4. When asked who needs coverage make sure you don't select your spouse.
See Coverage Examples Below