Planning your health or anticipating your health costs is not something we readily think about. It’s not something we care to calculate especially if your healthy, young-and-healthy, or if you’ve simply never had previous medical experiences that have cost you an arm and a leg, no pun intended.
But something about your health plan last year wasn’t quite the right mix. Maybe your deductible in 2018 was too high, or you realized that you were paying too much for your monthly premium. Maybe you’re just out of college and missed the age requirement to stay under your mother’s health insurance plan. You’re under pressure because you know Open Enrollment for 2019 is almost over. Even though the pressure of getting hit with a tax penalty for not having health insurance if off, you’re still under pressure to commit to a new health plan for another whole year.
Understanding how health insurance coverage works will allow you find the right plan for your particular circumstance. Don’t hesitate to speak with an independent insurance advisor to get the widest range of options and consultation. There are also state and local-sponsored assisters and certified application counselors who can help you. It’s not too late to start seeking help now: https://localhelp.healthcare.gov/#/.
Three Categories of Health Insurance Buyers
If you’re one of 1.6 million Iowans who purchased your health insurance plan through your employer in 2018, chances are your coverage for 2019 will continue through your comployee benefits so long as you’re still employed with that same company. Your deadline to submit changes, or decline your options would have already happened. If you’re not happy with any of the options your employer offers, check to see if it’s too late to decline coverage and take action fast to see what other plans you can buy in the open marketplace.
If you’re one of 107,000 Iowans who purchased individual plans last year (either privately or through the Affordable Care Act-compliant marketplace) and continue to fall in this same category for 2019, you still must choose a plan for 2019. According to an October press release by the Iowa Insurance Division, you will be re-enrolled into the same plan offered by Medica if you don’t elect a plan yourself. Perhaps you work for a small business who doesn’t offer health insurance benefits, or you are an entrepreneur, or a small business yourself. The good news is, you still have time to enroll! Open Enrollment ends on December 15.
The third category falls under public healthcare programs like Medicare and Medicaid, which covers about 1.2 million Iowans.
Health Insurance 101
As you quickly choose between your options before the December 15 Open Enrollment deadline, you’ll see these key terms that ultimately weigh on your individual contribution or cost of coverage. We want you to become familiar with these terms so you can move through your options quicker:
A deductible is the amount you pay for costs related to your health care service before your insurance starts to pay.
Example: If your plan’s deductible is $2,500, you’ll pay 100 percent of eligible health care expenses until your bill reaches $2,500. After that, you either share the cost with your insurance company by paying coinsurance. Your coinsurance can then be 20-80, at which point you would pay 20% of the rest of the bill while your insurance company pays the rest of the 80%, or you could be fully covered after the deductible.
Coinsurance is just as it sounds–the way you and your insurance company shares the cost of healthcare services. It’s usually shown as a percentage of the amount we allow to be charged for services. Coinsurance is a system that’s used with a deductible. Coinsurance kicks in after you’ve paid your plan’s deductible.
Example: You’ve paid $2,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan pays 80%. The 20 % you pay is your coinsurance.
A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service.
Example: Your plan determines what your copay is for different types of services, and when you have one. You may have a copay any time, independent of meeting your deductible or having coinsurance. In some cases, all you have to pay is a copay, while your insurance may cover the rest.
You insurance premium is the amount you pay for having an insurance plan. This is what you pay monthly to have coverage in place.
Finding The Right Insurance Plan Before December 15
Health insurance can be tricky and it requires a lot of forethought into the near future–something we don’t necessarily like to do. This is when you need someone to prod you with thoughtful questions so you can consider your options with more strategy, and so you can not only save on health care costs, but also work it into your overall financial health.
You may be able to find the right answers by yourself online, but you may not receive the full scope or breadth of how health insurance works with your entire financial health. Regardless, walking through the options with a licensed advisor will help you find the right insurance plan. It’s not too late.
About Ryan Ruffcorn
Ryan grew up in Keokuk, graduated from Keokuk Senior High, and started his agency in Keokuk from scratch in 2003 after having worked for one of the largest international accounting firms, KPMG, LLP.
Ryan is hardworking; his loyal and trustworthy character is exemplified by the way he does business. He thoroughly enjoys helping clients through the insurance buying process to secure coverage for their most valuable assets.