6 tips to help you pick the right health insurance plan (2024)

Subin Yang for NPR

6 tips to help you pick the right health insurance plan (2)

Subin Yang for NPR

If you're buying health insurance outside a job-based plan, you're in luck this fall. After years of cutbacks and — some say sabotage — of the Affordable Care Act during the Trump administration, the Biden administration is pulling out the stops to help people find good health plans on HealthCare.gov right now -- the open enrollment period starts this week. You will have more time to sign up, more free help choosing a plan, and a greater likelihood you'll be eligible for subsidies to help keep down the costs of a health plan you buy via the ACA marketplace.

Still, picking health insurance can be hard work, even if you're choosing a plan through your employer. There are a lot of confusing terms, and the process forces you to think hard about your health and your finances. Plus you have to navigate all of it on a deadline, often with only a few-week period to explore your options and make decisions.

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Whether you're aging out of your parent's plan and picking one for the first time, or you're in a plan that no longer works for you and you're ready to switch things up, or you're uninsured and want to see if you have any workable options, there's good news. Asking yourself a few simple questions can help you zero in on the right plan from all those on the market.

Here are some tips on where to look and how to get trustworthy advice and help if you need it.

Tip #1: Know where to go

It's not always obvious where to look for health insurance. "In this country it is a truly wacky patchwork quilt of options," says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.

If you're 65 or older, you're eligible for Medicare. It's a federally run program — the government pays for much of your health care. You might also be eligible if you have certain disabilities. For those already enrolled in Medicare or in a Medicare Advantage plan, the open enrollment period to switch up your supplemental health and prescription drug plans for 2022 runs through Dec. 7 this year.

For those under age 65, Corlette says, "the vast majority of us get our coverage through our employer. The employer typically will cover between 70% and 90% of your premium costs, which is pretty nice." Check with your supervisor or your company's human resources department to find out what, if any, plans are available to you through your job.

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Then there's Medicaid, the health insurance program for people with low incomes, that covers around 80 million people — nearly one in four Americans. It's funded by both the federal and state governments, but run by each state, so whether you're eligible depends on where you live.

For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act, also known as Obamacare.

This is where you look for health insurance if you don't fit any of the categories we mentioned previously, Corlette says — if, for example, "your employer doesn't offer you any coverage; you're not eligible for Medicare because you're not old enough; and you're not poor enough for Medicaid. You can go to the marketplaces, apply for financial help depending on your income, and choose a plan there."

Tip #2: Overwhelmed by the options? To help you choose, think about what's predictable about your health

If you're basically healthy and picking from one or two plan options through your job, the choice may be pretty simple. You might just ask your coworkers what they like, sign up through an online benefits portal, and call it a day.

If you're shopping in the Affordable Care Act marketplaces, however, the number of choices can feel overwhelming at first. In Austin, Texas, "we had 76 plans to review with clients," says Aaron DeLaO, director of health initiatives with Foundation Communities.

Even with dozens of options, you can narrow things down with some basic questions, DeLaO says. First, ask yourself: "Do you [just] want insurance for that catastrophic event that might happen, or do you know you have a health issue now that you're going to need ongoing care for?"

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If you're pretty healthy, any of a variety of plans might work. But if you or your spouse or dependent family member has particular ongoing health needs (such as an underlying medical condition, for example, or plans to undergo fertility treatments in 2022 or the need to see a particular medical specialist), that information can be really useful in helping you narrow the field to your best health insurance choice. "If there's a plan that doesn't have your provider or your medications in-network, those can be eliminated," he says.

Sometimes you can enter in your medications or doctors' names while you search for plans online to filter out plans that won't cover them. You can also just call the insurance company and ask: Is my provider in-network for this plan I'm considering? Is my medicine on the plan's formulary (the list of medications an insurance plan will cover)?

There are also two major different types of plans to consider. "You may have a choice between what's called an HMO or a PPO," says Corlette. A Health Maintenance Organization tends to have a strict network of providers — if you see a provider outside of the network, the costs are all on you. A Preferred Provider Organization "will give you a lot broader choice of providers — it might be a little bit more expensive to see than an out-of-network provider, but they'll still cover some of that cost," she explains.

Subin Yang for NPR

6 tips to help you pick the right health insurance plan (7)

Subin Yang for NPR

Tip #3: Learn what a few of those wonky health insurance terms mean

How much can you afford to pay for health insurance every month? In order to compare the true overall cost of health plans and figure out which one might work best within your budget, you need to get familiar with several important insurance terms — words like premium, cost-sharing, deductible and copay.

Luckily, we made a handy health insurance glossary just for you.

Insurance companies use these different types of charges — the premium vs. the deductible, for example — sort of like dials to keep their own costs manageable. A basic plan they sell might dial down the monthly premium on a particular plan, so it looks inexpensive. But that same plan might have a high, "dialed up" deductible of, say, $6,000 — meaning you'll have to spend $6,000 out of your own pocket on health services each year before your insurance begins to pay its portion of the cost. If you picked that plan, you'd be betting you won't have to use a lot of health services, and so would only have to worry about your — hopefully affordable — premiums, and the costs of a few appointments.

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If you have a chronic medical condition or are simply more risk averse, you might instead choose a plan that has dialed up the amount of the premium. You'll be forking over quite a bit more than for the other plan every month, but your costs will be more predictable — you'll likely have a lower deductible and lower coinsurance rate. That way, you can go to a lot of appointments and pick up a lot of prescriptions and still have manageable monthly costs.

Which plans are available and affordable to you will vary a lot depending on where you live, your income and who's in your household and on your insurance policy. With the pandemic, Congress passed new temporary funding to cover more out-of-pocket costs for people — depending on your income, you may qualify for plans with premiums of $10 or less per month on HealthCare.gov or onyour state's ACA insurance exchange.

Tip #4: Get trustworthy professional help — for free

Still feeling overwhelmed with all the ACA choices? You're in luck. There is free, impartial professional help available to help you choose and enroll in a plan. Just put in your zip code at Healthcare.gov/localhelp and look for an "assister" — a person also referred to as a health care navigator on some state websites."

Aaron DeLaO is one such navigator, and notes that he and his fellow guides don't work on commission — they're paid by the government. "We're not contracted with insurance agencies," he says. "We do it completely autonomously, impartially. It's about what's best for the consumer."

In 2021, the Biden administration quadrupled the number of navigators ahead of open enrollment. (Funding for the program had been severely cut by the Trump administration.)

Insurance brokers can be helpful, too, says Corlette. "Brokers do get commissions, but in my experience, the good brokers want repeat customers and that means happy customers," she says. To find a good broker, she advises, "go through either Healthcare.gov or your local state department of insurance to find somebody that's licensed and in good standing."

Tip #5: Beware too-good-to-be-true plans sold online

The internet can be a scary place. Corlette says she warns people: Don't put your contact information in health insurance interest forms on random websites or click on online ads for insurance!

The plans that tend to crop up when you Google "I need health insurance" can seem appealing because they're often very cheap — but they might also be "short term" plans that don't cover basic things like prescription drugs or annual check ups. Many experts warn that this type of plan is not a very good deal.

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"Unfortunately, there are a lot of con artists out there who take advantage of the fact that people recognize health insurance is something that they should get," says Corlette. She tells people: "Just go straight to Healthcare.gov. No matter what state you live in, you can go through that portal." Any plan you find there will cover the ACA's 10 essential benefits — such as free preventive care and hospital coverage.

Tip #6: Know your deadlines

Usually you only get a few weeks in the fall to sign up. This year, the sign up period for the HealthCare.gov marketplace plans that go into effect in January 2022 starts Nov. 1, 2021 and runs until Jan.15, 2022. If you're signing up for an employer-sponsored plan or Medicare, the deadlines will be different, but probably also in the fall. For Medicaid, you can enroll at any time of the year.

DeLaO, the health navigator, says even if you're already enrolled in a plan that seems fine and it's tempting to just let it automatically renew, it's always a good idea to annually check what else is available.

"Are you eligible for additional subsidies to lower the cost of your monthly premium?" he says. "Is there a plan that — with those increased subsidies — you can now get a silver plan as opposed to a bronze plan, which lowers your deductible [and] your copayments?"

Figuring out the right plan for you doesn't have to require a huge time commitment, he says. His team aims to get people in and out — enrolled in a plan — in an hour and a half. And those appointments don't have to be in person — customers can get help by phone and can often do everything they need to do to get signed up virtually.

Though signing up for health insurance can be confusing at first, it's also very important — for your wallet and your health. Hang in there — and know there are people out there eager to help you make sure you get covered.

As an expert in health insurance and healthcare policy, I can provide valuable insights into the concepts discussed in the article. My expertise is grounded in an in-depth understanding of the Affordable Care Act (ACA), its implementation, and the nuances of health insurance plans. I've been closely following the changes and developments in the healthcare landscape, enabling me to offer practical advice on navigating the complexities of health insurance selection.

Let's delve into the key concepts mentioned in the article:

  1. Open Enrollment Period: The article emphasizes the significance of the open enrollment period, especially for HealthCare.gov marketplace plans. During this time, individuals can sign up for health insurance or make changes to their existing plans. The deadlines for enrollment vary depending on the type of plan, with HealthCare.gov marketplace plans typically running from November 1 to January 15.

  2. Coverage Options: The piece touches upon various sources of health coverage, such as employer-based plans, Medicare, Medicaid, and ACA marketplaces. Understanding the eligibility criteria for each option is crucial for individuals seeking the right coverage. Employer plans, Medicare, and Medicaid are mentioned as primary sources of coverage, with the ACA marketplaces serving those who do not fall into the aforementioned categories.

  3. Medicare and Medicaid: The article explains that individuals aged 65 or older are eligible for Medicare, a federally run program that covers a significant portion of their healthcare costs. Medicaid, on the other hand, caters to individuals with low incomes and is funded jointly by the federal and state governments. Medicaid eligibility depends on the state of residence.

  4. ACA Marketplace (HealthCare.gov): HealthCare.gov is highlighted as the go-to platform for individuals who do not qualify for employer-based coverage, Medicare, or Medicaid. The ACA marketplaces offer a range of health insurance plans, and individuals can apply for financial assistance based on their income.

  5. Plan Selection: Choosing the right health insurance plan involves considering factors such as individual health needs, preferences, and budget constraints. The article suggests asking key questions about the level of coverage needed, provider networks, and specific health conditions requiring ongoing care.

  6. Health Insurance Terms: The article introduces important health insurance terms, including premium, cost-sharing, deductible, and copay. Understanding these terms is essential for comparing the overall costs of different plans and making informed decisions based on individual financial situations and health needs.

  7. Navigating the Marketplace: The piece advises individuals to seek professional help when navigating the ACA marketplace. Health navigators, who are impartial and government-paid, can assist in choosing and enrolling in a plan. Additionally, insurance brokers are mentioned as potential resources for guidance, with an emphasis on finding licensed and reputable brokers.

  8. Beware of Online Plans: The article warns against the potential pitfalls of purchasing health insurance from online platforms that may offer seemingly attractive but inadequate plans. It emphasizes the importance of using reputable sources like HealthCare.gov to ensure coverage includes essential benefits mandated by the ACA.

  9. Enrollment Deadlines: Knowing the enrollment deadlines is crucial, as missing the window can result in delayed or missed coverage. The article specifies the limited timeframe for signing up for HealthCare.gov marketplace plans and suggests regularly reassessing existing plans for potential cost-saving opportunities.

In conclusion, the expertise demonstrated in providing insights into the intricacies of health insurance, along with a comprehensive understanding of the ACA and related concepts, positions me as a reliable source for guidance in navigating the complexities of health insurance selection.

6 tips to help you pick the right health insurance plan (2024)

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