Filing claims: With HMOs you typically don’t have to file any claims yourself. With PPOs you may have to file some claims – especially if you go out of network for care.
When deciding between an HMO or a PPO it’s important to consider your budget but also your health care needs and preferences. For instance, if you’re on a tight budget an HMO may be a better option for you. However, if flexibility with your health care is important to you a PPO may be the right choice.
Making these decisions can be difficult and daunting considering you typically are locked into your plan for a full calendar year. If you’re having a hard time making a decision, or just need someone to talk through your options with, eHealth’s licensed insurance agents are here to help you make the right decision for your specific needs.
If you need help making the decision between an HMO or a PPO for your small business, eHealth can help with that too!
You may have seen these other acronyms when shopping for health insurance or looking through your benefits package through your job.
HSAs, or Health Savings Account, is a tax-advantaged account owned by an individual with a high deductible health insurance plan. Both the person on the account and their employer can contribute a certain amount of money to the account each year.
HRAs, or Health Reimbursement Arrangements, are employer-funded plans where employees can be reimbursed by their employer for qualified medical expenses and insurance premiums. These are not bank accounts, they are an agreement between employee and employer.
Additionally, FSAs are a similar arrangement to HSAs, but the tax-advantaged account is connected to the employer rather than the employee.
Another notable difference between HSAs and HRAs is that because HSAs are owned by the employee, they stay with them even if they chose to leave their job. You can learn more about the differences between HRAs and HSAs in our more detailed article.
There is plenty of confusing health insurance industry jargon that you’re bound to encounter when you’re shopping for coverage. Let’s define some of these key terms:
Premium: Your premium is the amount of money you pay to your health insurance company each month to stay enrolled in your plan and keep your coverage.
Deductible: This is the amount of money you must pay out-of-pocket before your health insurance starts paying for health care services.
Copay: Copays are types of cost sharing payments you may have to make out-of-pocket when you receive certain health care services or medications. They’re typically a flat rate; for example, $10 per doctor’s visit or $15 for certain medications.
Coinsurance: Coinsurances are another type of cost sharing payment you may have to make out-of-pocket when receiving certain health care services or Medications. These are usually in the form of a percentage. For instance, let’s say you have a 10% coinsurance for a doctor’s visit that costs $100. You will pay $10 for every $100 your insurance pays for a doctor’s visit.
Out-of-pocket maximum: This is a cap on how much you’ll have to pay out of pocket for health care in one year. After you reach this amount your insurer will pay for your covered care in full for the rest of the year. For example, if you have a $44,000 out-of-pocket limit and you’ve met your $4,000 deductible and paid $40,000 in other cost-sharing payments (like copays or coinsurances), you’ve met your limit and your insurance company will pay for any covered care for the rest of the year. Affordable Care Act compliant plans require all major medical health insurance plans to have an annual out-of-pocket maximum for each beneficiary.
Every health insurance plan is categorized by different metal ratings based on how much coverage they offer. There are 5 levels of coverage you can get with an ACA plan:
Bronze: You can expect to pay 40% of the costs for covered care with your plan paying 60%, these plans have the highest out-of-pocket costs with the lowest premiums.
Silver: You can expect to pay 30% of the costs for covered care with your plan paying 70%, these plans have high out-of-pocket costs with low premiums.
Gold: You can expect to pay 20% of the costs for covered care with your plan paying 80%, these plans have low out-of-pocket costs with high premiums.
Cyber Security QuotesPlatinum: You can expect to pay 10% of the costs for covered care with your plan paying 90%, these plans have the lowest out-of-pocket costs with the highest premiums.
Catastrophic coverage: In addition to the 4 metallic levels of coverage, you may have the choice to get a plan with catastrophic coverage. Catastrophic coverage is a type of coverage available to those under 30 or those who qualify for a “hardship exemption”. They are designed to protect you in a worst-case scenario, hence the name “catastrophic” coverage. These plans have very high-deductibles and low premiums.
The cost for health insurance plans varies greatly depending on the type of plan and level of coverage. Even if you stay with the same health insurance plan year after year, you can expect the cost of your plan to change yearly.
According to a recent study by eHealth, the average health insurance premium is $484 for individuals and $1,230 for families. However, actual prices available depend on zip code, age, gender, and other factors. Browse health insurance by state to find plans and see pricing in your area.
It’s also important to consider more than your monthly payments when choosing a plan. Even if you choose a plan with a lower premium, you may end up with a higher deductible, which could lead to you having to foot large medical bills before your insurance kicks in.
Be sure to not only consider your budget but your past and present health needs. You may find you will save money with a plan that has a higher monthly premium and lower deductible if you’re someone who needs frequent hospital or doctor’s visits.
If you are unsure what plan is best for your needs and your budget, one of eHealth’s licensed health insurance agents can help you make the right decision. You can check out our other resource center content on health insurance costs as well.
If you are unsure what plan is best for your needs and your budget, one of eHealth’s licensed health insurance agents can help you make the right decision. You can check out our other resource center content on health insurance costs as well.
Depending on the type of health insurance you are looking for and other relevant circumstances in your life, you may be able to buy health insurance at any point in the year, or you may have to wait until the Open Enrollment Period, which is the annual period when you can enroll in ACA major medical health insurance plans. Open enrollment periods may vary by state, so check out the full list of Open Enrollment Periods by state to see when you’ll be able to find an ACA plan.
That being said, if you experienced a qualifying life event (loss of employer-sponsored health insurance, divorce, relocation to a new coverage area, etc.) you may be eligible for a Special Enrollment Period, which would allow you to sign up for an ACA plan outside of OEP.
Additionally, Medicare has a separate Annual Election Period, and many other types of insurance plans, like short term health insurance plans, can be purchased year round. If you have specific questions on when you can sign up for specific health insurance plans, the eHealth team can help you figure out when you can purchase the right plan for you.
There are a few places where you can buy health insurance. You can go through your state or the federal marketplace or through an insurer.
You can also shop with eHealth, the first and largest independent online health insurance marketplace. Choose from over 10,000 plans from over 180 insurance companies. We’re unbiased and we’re here to help you find the right plan for you, your family, or your small business.
Find ACA coverage or fill a coverage gap with a short-term insurance plan from our selection of over 3,600 plans from over 16 carriers.
Once you’ve found the right plan, let eHealth be your health insurance advocate. Our customer support team is willing and able to answer any questions you may have about your plan’s coverage, billing, or any other tricky aspects of health insurance.
We’re here for you around the clock! With our online chat function, email, and phone support we’re available 24/7.
We’re committed to helping make health insurance affordable and easy. We’ve done it for over 5 million customers, let us help you too!