Three Tips to Help with Finding Health Insurance for Individuals

It is essential to have adequate health insurance coverage as you never know when mishaps might occur, or when ill health could interrupt the steady tenor of your life. And the cost of medical services can be astronomical if you don’t have the right health insurance. A heart bypass surgery, for instance, can cost up to $200,000 or more without health insurance. High medical costs are one of the leading causes of debts, financial problems, and bankruptcies in the United States. So, to be on the safe side, the sooner you take out health insurance for yourself, the better.

Here are three tips to help you find the right Texas health insurance for individuals:

1. Get Informed About the Affordable Care Act

The Affordable Care Act is a federal law that makes it mandatory for almost all American citizens to get health insurance. Due to this law, insurance companies cannot refuse you coverage or charge you higher premiums if you have any pre-existing health conditions. You can get a comprehensive individual health insurance plan that covers preventive care, hospitalization, emergency services, and much else. You may also be eligible for Medicare and Medicaid.

Insurance plans under the Affordable Care Act, however, may not cover dental and vision healthcare costs if you are above 21. You can get insurance through your employer, through the public or federal marketplace, or from private insurance companies.

2. Understand the Key Health Insurance Costs

The key health insurance costs are premiums, deductibles, coinsurance, copayments, and out-of-pocket maximum.

• A premium is the monthly, quarterly, or annual payment on a health insurance plan, which you must make whether you get medical care or not.

• A deductible is an out-of-pocket payment you will make in a year for covered medical services before your insurance provider begins paying.

• Coinsurance is the portion of the healthcare bill that you must pay after you’ve met your deductible.

• A copayment is the fixed amount you must pay when you visit a medical provider for your healthcare needs.

• An out-of-pocket maximum is the maximum healthcare payment you will make in a year. It includes your deductible, coinsurance, and copayment amounts.

Generally, health insurance plans that require lower premiums have higher deductibles, and plans with higher premiums come with lower deductibles. To select the right Texas health insurance for individuals, consider how often you will require medical care in a year. If you are in good health, go for a lower premium and higher deductible plan. Otherwise, pick a higher premium plan with a lower deductible.

Keep health insurance costs down by using medical care providers from the plan’s network. Additionally, you can benefit from the Affordable Care Act by getting cost-sharing assistance and premium tax credit to pay for your health insurance costs.

You will need to buy a silver plan to avail of cost-sharing assistance; there are four plans- bronze, silver, gold, and platinum, depending on the costs you share with the insurance company. If you pick gold or platinum plans, you will have to pay higher premiums, and the plan will pay more of your total healthcare costs. The lower premium bronze and silver plans will pay less of your healthcare costs.

3. Find Out About Marketplace Plan Types

The four main types of marketplace plans are:

• Health Maintenance Organization (HMO)—provides coverage only if you visit care providers on the plan network, and if you live or work in the service area.

• Exclusive Provider Organization (EPO)—you can only use the medical providers that are on the plan network, except in emergencies, of course.

• Point of Service (POS)—you must get a primary care doctor from the plan network and get their referral if you need to see a health specialist. You can also pay less if you use the medical service providers on the network.

• Preferred Provider Organization (PPO)—you can pay less if you use the providers on the network. If you go to other providers, you will have to pay more.

It will be a good idea to compare the different insurance plan types and pick the one that can offer you the most benefits for your situation.