Once you decide you need coverage, you need to decide where you are going to be enrolling in health insurance. Does your employer offer it? Do you want a private insurance company? These are things to consider. There are a few things to think about when enrolling in health insurance.

Things to Consider

First things first, when can you buy health insurance in your state. Most insurance companies have an open enrollment period. This is the one time a year new enrollees or current members can change their plan for free, unless there is a special reason, then you can change it during the special enrollment period. This year the state of Florida’s open enrollment period is November 1st, 2020-December 15th, 2020. During this time, you can sign up for insurance and choose any plan you want, depending on how much you want to pay.

Special Enrollment Qualifying Events

  • Getting married
  • Having a baby
  • Adopting a child
  • Moving
  • Becoming an American citizen
  • Leaving incarceration
  • Losing an insurance due to job loss, divorce, or aging off a parent’s plan
  • COBRA (Consolidated Omnibus Budget Reconciliation Act) expiration
  • Losing eligibility for Medicaid or the children’s health insurance program
  • People with a marketplace plan may already be eligible for a special enrollment change if there has been household income change, household status that affects eligibility for premium tax credits or cost-sharing subsidies
  • Gaining status as a member of an Indian tribe

Included in Coverage

Before the ACA, individual healthcare plans’ coverage varied widely. Insurers could deny your application for insurance or set exorbitant premiums if you had any health conditions at all. Now insurers have lost that power. They have to cover you despite your past medical history. In addition, all individual healthcare plans must cover at least a set of 10 standard essential health benefits:

  • Outpatient services, including doctor’s visits
  • Emergency room visits
  • Hospitalization
  • Pregnancy
  • Maternity care
  • Mental Health and Substance Abuse treatment
  • Prescription Drugs
  • Services and devices for recovery after an injury or due to a disability or chronic condition
  • Lab tests
  • Preventative services, including health screenings, immunizations, and birth control. You may pay nothing out of pocket for preventative care when you see healthcare providers in a health plan’s network.
  • Pediatric Services, including dental and vision care for kids

Types of Individual Health Plans

Health insurance plans don’t differ that much in term of benefits. Where they differ is the plans costs, the way they are structured, which doctors accepts that insurance or that specific plan, and which prescription drugs they cover.

Healthcare plans in the Affordable Care Act are broken into 4 different metal categories. This makes them easier to compare. The categories are based off how much you would be paying versus how much the insurance would be paying towards your coverage. The costs are the out-of-pocket costs that include deductibles, co-payments, and co-insurance.

These percentages are estimates based off of the amount of medical care an average person would use in one year:

  • Bronze- Plans pays 60% of your health care costs. You would pay 40%. The average premium for this plan is $440 monthly.
  • Silver- Plans would pay 70% of your healthcare costs. You would pay 30%. The average premium for this plan is $481 monthly.
  • Gold- Plans would pay 80% of your health care costs. You would pay 20%. The average premium for this plan is $596 monthly.
  • Platinum- Plans would cover 90% of your healthcare costs. You would pay 10%. The average premium is $706 monthly.

Generally, the less you pay for deductibles, co-insurance, and co-payments would mean the premium would be higher. The Platinum plan cover much more of the costs associated with the services you would receive, but that would mean that your monthly premium would be much higher.

Making a well-educated individual health insurance decision requires time and effort, but doing the research now will pay off later.