Your health insurance is probably one of the most important decisions you make on a yearly basis unfortunately it's probably also one of the most confusing so today let's talk about how to pick the best health insurance plan for you on healthcare.gov.
Welcome back my name is sarah and welcome to health broker's channel so like i said we're going to be talking today about how to pick the best plan but first i gotta say the easiest way to pick the best plan is to use a broker and yes i know at ihealthbrokers we are health insurance brokers but really and truly.
It is the easiest and best way to ensure that you're getting the right plans for your budget and for your needs a lot of people are under the false impression that if they contact the insurance company directly which is the carrier or go through healthcare.gov that they're somehow going to get a discount.
On their health insurance and that's not at all true if you're looking at a specific plan no matter which route you go to enroll your monthly premium isn't going to change there isn't going to be any type of incentive yes there are commissions and things like that that's how agents.
Of the carrier and brokers get paid but those are already included in your monthly premium so if you have a broker that you trust that you want to work with please go that route a broker is a third-party liaison who works for you not the insurance company which is the carrier so they're going to be able to.
Ask you the right questions to make sure that your health insurance plan not only fits your budgets but it fits your needs if you'd like our help you can reach us here at eye health brokers at 888-410-0344 there is absolutely no charge for our services and that is the case with many brokers so please.
If you're going to go the healthcare.gov route please use a broker i promise you it's going to make your life a lot easier oh while i'm at it please make sure to like this video we release these videos on a weekly basis designed to educate our clients and our viewers about health insurance it's a really.
Important topic that a lot of people are pretty confused by so we want to make sure that our viewers and our clients are making the best decisions possible when it comes to their health insurance so we want to get this information out there so please make sure to like this video and of course subscribe.
Because we do release these videos on a weekly basis so today we're going to be talking about how to pick the best plan for your needs on healthcare.gov basically it boils down to two things which is your budget and your needs first let's talk about budget that's the.
Easiest part to understand because well you probably have a hard number in your mind of what you can afford to allocate for health insurance so basically you need to take into consideration your monthly premiums the deductible co-pays or coinsurance which is the cost-sharing aspect and then of course the out-of-pocket.
Maximum sometimes called out-of-pocket limits so let's start with monthly premiums that's the easiest one to understand your monthly premium is the amount that you pay out of pocket on a monthly basis to keep your insurance active it can range quite a bit dependent upon.
The plan that you choose and the range of benefits the middle tier and of course how many people you're looking to insure now your monthly premium is where you may see a type of savings reflected if you're eligible for one of those premium tax credits which we talk about.
Plenty in other videos there's four different tiers that you're going to choose from you're going to look at bronze silver gold and platinum and you may notice that bronze plans tend to have lower monthly premiums and as you move towards platinum you may notice that those premiums get a bit higher.
That's not a hard and fast rule but it is a pattern that you'll probably notice then there's your deductible your deductible is the amount that you have to meet out of pocket before your insurance kicks in so for a lot of these services basically you're going to have to pay a hundred percent until you meet that.
Deductible and then the cost sharing will begin at that point you're responsible for co-pays or coinsurance now you'll probably notice that with bronze plans those deductibles tend to be a little bit higher and as you move towards the platinum plans they tend to get a little bit.
Lower again not a hard and fast rule just a pattern that you're probably going to notice and there are some exceptions to the deductible so under the aca the affordable care act sometimes called obamacare there is a list of essential benefits.
That all health insurance plans must offer now oftentimes these services are actually offered at no charge whatsoever even before you've met your deductible or your out of pocket max and even if you haven't met your deductible many of these services.
Will be offered with just copay or coinsurance so you won't be responsible for the entirety of the cost it's a very extensive list it pretty much consists of preventative services as well as screenings and diagnostics you know very routine care so i'm going to put a link to the page listing all of those essential benefits.
As well as a link to the page that details specifically which ones are at no charge i'm going to put that in the description below so that way you can take a look on your own time otherwise we'd be here all day with me listing every single one of those essential benefits something else to take into consideration with your.
Deductible okay so many plans have just one deductible where basically your prescription drug needs and your medical services are all going to apply towards that deductible however some plans have two separate deductibles one for.
Prescription drugs and one for your health services now if that's the case then obviously every time you purchase prescription drugs then that's going to go towards your prescription drug deductible and if you go to the doctor use medical services that's going to apply towards your other deductible.
You have to meet these separately that can be a little bit difficult if you have extensive prescription drug needs so it's something to take into consideration now there's a lot of different variables and that's why health insurance can be confusing okay cost sharing now later in this video we're going to talk.
About why this is so important but let me give you a breakdown on what cost sharing is so once you've met your deductible at this point your insurance kicks in and they're going to contribute to a portion of the cost of covered services and in network services we're going to talk.
More about that later as well this is how those different metal level plans are actually delineated a bronze level plan is going to cover 60 of the costs with you being responsible for 40 a silver level plan is going to cover 70 with you being responsible for 30. a gold is going to cover 80.
With you being responsible for 20 you see where this is going and a platinum is going to cover 90 with you being responsible for 10. so that's really why very often we see higher monthly premiums on platinum plans because the cost sharing is so much lower now here's a little bit of a.
Disclaimer if when you're applying for your insurance on healthcare.gov if you're eligible for not only a premium tax credit but extra savings then you're going to see an asterisk pop up and it's going to tell you that you may get these extra savings but.
Only on silver plans so if you're eligible for this type of tax credit plus those extra savings it'll let you know that you may have lower monthly premiums lower deductions and a lower cost share so as opposed to being responsible for 30 percent maybe you'd be responsible.
For 20 or 10. it depends upon your plan so that's also something very very important to take into consideration finally there is out-of-pocket maximums also known as out-of-pocket limits these are extremely extremely important regardless of what health insurance route.
You pursue an out-of-pocket limit or out-of-pocket maximum is really important because basically it can help to save you from crippling medical debt which unfortunately a lot of people that find themselves in unexpected medical situations dire medical emergencies they find themselves.
With major medical debt when they don't have those out-of-pocket limits or out-of-pocket maximums so in 2021 under the aca those plans have a max of eight thousand five hundred and fifty for an individual and seventeen thousand one hundred.
Dollars for a family basically what this means is once you've hit that max or that limit your insurance is going to cover the rest of the costs now i do need to tell you that your monthly premiums don't count towards these out-of-pocket maxes.
So as you're paying that monthly premium on a monthly basis your insurance is not keeping track of that what they are keeping track of is your deductible and any co-pays and coinsurance that you pay so your insurance company which is the carrier is keeping track of that and once you.
Hit that out-of-pocket max or out-of-pocket limit they're going to take over for 100 of the costs however they are not keeping track of any out-of-network services that you may be using or benefits or services not covered so that is not going to.
Apply to your out-of-pocket limit and also even once you've hit that out-of-pocket limit if you're utilizing out-of-network doctors or if you're taking advantage of benefits not covered by your specific plan you're still going to be responsible for those charges make sense.
Now when you're looking at different plans you'll notice that sometimes plans are going to offer the max as set by the government but some plans may offer lower maxes so that's something else that you're going to want to take into consideration the more difficult aspect to understand.
Is really what your specific health needs are obviously you can't predict the future budget is much easier to look at and say this is a hard number this is what i can afford and it's very easy to gravitate towards those plans that seem like they are going to be less expensive but a.
Lower monthly premium may not be less expensive in the long run so you need to ask yourself a couple of questions how often do you and your family visit the doctor other than the free services offered by marketplace plans how often do you make use of those other essential benefits.
Do you have any conditions that might require more frequent visits or in-depth tests do you have any specialty medical needs that might require a plan with more elaborate benefits and do you have any monthly prescriptions you'll also need to understand the plan itself to determine which plan best suits your needs do you.
Need the flexibility of a ppo or can you work with an hmo or epo do you have a network of doctors and hospitals that you prefer do they accept your plan so now you're probably starting to see that picking an inexpensive plan may seem like a good idea and i'm not saying it's not in all.
Honesty for a lot of people those bronze plans or plans with lower monthly premiums may be great but it just depends does your plan accept your doctors and the hospitals that you use if it doesn't well then you're going to have to pay out of pocket for that and that's going to be a huge waste of money.
Also does your plan offer the benefits that you need if you need additional benefits and those services are not covered by your specific plan regardless of how much you're paying for it on a monthly basis well you're going to have to pay for those benefits out of pocket.
And that's going to be an additional cost so this is why you really need to have an honest conversation with yourself about your budget and your medical needs this may seem like a lot to take into consideration and it is but we're not done yet what about dental vision or other fringe benefits that you.
Might need well you can certainly access those on healthcare.gov and maybe the plan that you're interested in already has them or maybe you want to add them on but then you need to compare those costs with possibly purchasing a healthcare.gov a.
Marketplace plan without those fringe benefits and then purchasing something like dental from a private insurance company very often you'll find that there will be a cost savings and you're going to have more choice so that's more to take into consideration then.
There's even more then we have to look at plans that offer hsas so a lot of people are looking to take advantage of that triple tax benefit that hsas which is health savings accounts offer but those are only offered in conjunction with high deductible health plans.
And is a high deductible health plan right for you we're not going to talk about that anymore today because that's a whole long and extensive topic so make sure to check out our video that's all about hsas and high deductible health plans i'm going to put that.
In the description below and then finally we have to talk about those premium tax credits so dependent upon your income range you may be eligible for a premium tax credit which can save you thousands of dollars but what if you're right on the cusp for becoming eligible how do you make sure that you can take.
Advantage of those premium tax credits that's another video in itself and i'm gonna put that in the description below as well basically like i said before there's so much information on healthcare.gov and so many decisions and so much minutia that it can really really make your head.
Spin and then you add into that the pressure of this extremely important decision and it's understandable why so many people find it overwhelming so again i say if you have a broker that you trust please go with a licensed trusted broker somebody that can help you.
Navigate the world of health insurance to make sure that you're getting the right plan for your needs there is no one-size-fits-all answer and if you'd like our help you can reach us here at eye health brokers at 888-410-0344 we're licensed nationwide with over 200 carriers and there is no.
Charge for our services now if you liked this video please make sure to click like and subscribe as well to stay up to date on all things health insurance and if you have any comments questions anything any videos you'd like to see let us know in the comments below and we'll make sure to get on it.
Thank you so much and have a great day bye you