This is the question millions of Americans will be asking themselves over the next few months and it is a crucial one. There are many factors involved in your decision to purchase individual major medical insurance. Some crucial ones are;
1) Will my or my family's expected income for 2015 fall in the range that would qualify me/us for a premium subsidy and possible cost sharing reductions for coverage purchased through the government health insurance marketplace (100% to 400% of the Federal Poverty Level)?
2) If I do qualify for a subsidy is it enough to influence my buying decision? Premium subsidies peak in the 250% to 300% of the Federal Poverty Level zone and decline rapidly from there. For example, an individual making $40,000/yr would technically qualify for a subsidy but the dollar amount would be small enough that you may decide its not worth the trouble (this may be especially true in states with limited carrier choices in the government marketplace).
3) Are the doctors, hospitals and pharmacies I want to use in-network providers with the health plan I am considering enrolling in?
4) What is the coverage for prescription drugs in the plan I am considering? Are the prescription drugs I am already taking covered by the formulary of the health plan I am considering? And, if they are, at what level are they covered and might I be forced to revisit the steps that led me to finding the prescription medication that works for me and my health condition before my new health plan would cover them?
4) What coverage does the health plan I am considering offer outside of my home area? Can I plug into a national network of providers wherever I might be or is my coverage largely restricted to my home service area?
5) If I am diagnosed with a serious illness like cancer will the health plan I am consider cover services from providers like M.D. Anderson, the Mayo Clinic and other nationally recognized centers of excellence? The consumer can no longer just assume that this will be the case.
While these questions don't cover all the questions a person should ask, if you get the answer you like for the questions I've posed you will have a much higher probability of being satisfied with the health insurance plan you select.
For the vast majority of people, you will be better served to seek out the services of an experienced health insurance agent who is familiar with the insurance carriers available in your market and who can help guide you to the plan the best suits your needs whether it is inside or outside of the government health insurance marketplaces.
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1) Will my or my family's expected income for 2015 fall in the range that would qualify me/us for a premium subsidy and possible cost sharing reductions for coverage purchased through the government health insurance marketplace (100% to 400% of the Federal Poverty Level)?
2) If I do qualify for a subsidy is it enough to influence my buying decision? Premium subsidies peak in the 250% to 300% of the Federal Poverty Level zone and decline rapidly from there. For example, an individual making $40,000/yr would technically qualify for a subsidy but the dollar amount would be small enough that you may decide its not worth the trouble (this may be especially true in states with limited carrier choices in the government marketplace).
3) Are the doctors, hospitals and pharmacies I want to use in-network providers with the health plan I am considering enrolling in?
4) What is the coverage for prescription drugs in the plan I am considering? Are the prescription drugs I am already taking covered by the formulary of the health plan I am considering? And, if they are, at what level are they covered and might I be forced to revisit the steps that led me to finding the prescription medication that works for me and my health condition before my new health plan would cover them?
4) What coverage does the health plan I am considering offer outside of my home area? Can I plug into a national network of providers wherever I might be or is my coverage largely restricted to my home service area?
5) If I am diagnosed with a serious illness like cancer will the health plan I am consider cover services from providers like M.D. Anderson, the Mayo Clinic and other nationally recognized centers of excellence? The consumer can no longer just assume that this will be the case.
While these questions don't cover all the questions a person should ask, if you get the answer you like for the questions I've posed you will have a much higher probability of being satisfied with the health insurance plan you select.
For the vast majority of people, you will be better served to seek out the services of an experienced health insurance agent who is familiar with the insurance carriers available in your market and who can help guide you to the plan the best suits your needs whether it is inside or outside of the government health insurance marketplaces.