Your deductible is the amount you must pay in medical expenses prior to receiving any benefits. Your ideal deductible should be determined by your average annual usage of healthcare.
Your copay is the amount you are responsible for towards physician visits, prescriptions, urgent care, labs, etc. Your coinsurance is the percentage of costs you pay once you've met your deductible.
Your out-of-pocket max is the most you have to pay for covered services in a plan year. Your OOPM varies based on the level of coverage you choose and should be a realistic amount you can contribute in the case of a catastrophic event.
Your network is what determines your access to Hospitals, facilities, and physicians. A PPO lets you choose any physician you like, either inside or outside of your network without needing to obtain a referral from a primary care Physician. An HMO only allows you to see a particular group of physicians within your network, referrals must be obtained to see any kind of specialty physician.
UnitedHealthcare, part of UnitedHealth Group, is the largest health insurance company by total members. Its policies can be purchased in all 50 states. Along with having the most members, UnitedHealthcare also has a network of over 1.3 million physicians and healthcare professionals, with more than 6,500 hospitals. This means that if you have UnitedHealthcare, you will have many options to choose from to receive care.
Anthem is the second-largest medical insurance provider by total members, with more than 45 million members. Anthem is part of the Blue Cross Blue Shield Association. This means that when searching for Anthem policies on your state marketplace exchange, you may find products with the BCBS name, but you will be buying from Anthem. Available in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin.
Aetna was acquired by CVS Health Corp. in 2018. CVS Health now operates the company and has been able to seamlessly integrate its provider networks with Aetna's membership base. Founded in 1853, Aetna is the third-largest provider of health insurance and services, by membership. However, much of its membership comes from providing health insurance to employers and their employees in the private market. Aetna returned to a limited number of ACA marketplaces for the 2022 plan year.
Cigna is the fourth-largest major medical insurance company in the United States. Cigna currently offers individual health insurance in Arizona, Colorado, Florida, Georgia, Illinois, Kansas, Mississippi, Missouri, North Carolina, Pennsylvania, Tennessee, Utah, and Virginia.
Humana comes in as the fifth-largest health insurance company by membership. Humana has not offered new individual ACA health insurance since January 2018 but will continue to honor its existing ACA policies. Humana is now focused on serving the Medicare market, with either a Medicare Advantage or a supplemental plan (or both) available in every state.
The public marketplace is comprised of all plan under the Affordable Care Act (ACA). The ACA's major provisions came into force in 2014. This act allows individuals under the Federal Poverty Level (FPL) to apply for subsidies therefore qualifying for more affordable health care. The ACA also allowed individuals to qualify for coverage regardless of pre-existing conditions.
If you qualify for government income-based subsidies or have major pre-existing conditions this may be the best route for you.
The private market is predominantly made up of health-based or medically underwritten policies which means the insurance companies are more selective on who they take allow on these policies. Making them more exclusive, allowing the company to endure less risk and in turn, offer more competitive rates and coverage to those that do not qualify for a larger subsidy or have minor/controlled pre-existing conditions.
The easiest way to ensure you qualify for these plans and evaluate all your options on both the public and private market is to book a quick meeting with a licensed advisor.
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