Consider these statements about what is most important when it comes to health insurance plans –
- It’s important to have an insurance plan you’re comfortable with
- It’s important to purchase an ACA-compliant health plan from an established, quality company
- It’s important that the health plan includes your favorite doctor, hospital and clinic in its network
- And it’s important that your health plan provider offers accessible, knowledgeable and helpful customer service
Assuming that the above statements are true, a good health insurance plan is not “one size fits all.” People’s needs in health insurance differ depending on their unique situation. Here are three situations that may require different approaches to finding a good fit in a health insurance plan –
A YOUNG, SINGLE, HEALTHY ADULT WHO DOES NOT USE HEALTH CARE SERVICES OR TAKE MEDICINE REGULARLY
In the past, many young people who did not have health coverage through their employer or school simply went without it. Today, the Affordable Care Act (ACA) requires everyone to have health insurance, or face a fee for not complying. Several good health insurance plan choices for young adults in Wisconsin are now available –
- Up to age 26 – Option to remain on their parent’s health plan until age 26
- Up to age 30 – Option to choose a Catastrophic plan (available until age 30) that features low premiums with high deductibles, but includes preventive care at no copay
- After age 30 – Option to choose a Bronze health insurance plan that features a good selection of doctors, hospitals and clinics in-network. These plans offer lower premiums and higher out-of-pocket costs
A FAMILY WITH TWO CHILDREN AND NO CHRONIC HEALTH PROBLEMS
A number of good health insurance choices are available for families. While family members may not have chronic health problems, it is likely that family members will need health care services during the year for common health problems. These may include ear aches, sore throats, minor injuries and so on.
The decision about which health plan to choose comes down to whether the family is comfortable paying more or less when they use health services. Generally, higher premium payments indicate lower copays and other out-of-pocket costs. It is also possible that the family may qualify for subsidies that help pay for health care premiums. This is dependent on the family’s income.
Some options worth considering include –
- Silver level plans that offer copays of $30 or less and no coinsurance would provide good coverage for simple office visits (the family may have reduced premiums if they meet ACA requirements)
- A Bronze Plan with a Health Savings Account – if the family wants very low premiums and the opportunity to save money for health care expenses, this is a good option. The plan won’t pay until the deductible is reached, but health care services will be paid from the tax-free health savings account
A WISCONSIN COUPLE OF AVERAGE HEALTH APPROACHING RETIREMENT
As people approach retirement, there are a lot of decisions to be made regarding health insurance. Everyone wants to find a good health insurance plan that’s right for their situation. Options for this couple include keeping their employer-based insurance, going on their spouse’s insurance plan, or signing up for Medicare.
Most people sign up for Medicare Part A within a three month period before or after their 65th birthday. Medicare Part A covers hospital expenses and has no premium for anyone who has paid Medicare taxes for more than a decade (or is married to someone who has).1 You may also want to sign up for Medicare Part B when you retire because it covers most other medical expenses except prescription drugs.
Twenty-five percent of people with Medicare also purchase a “Medigap” policy to supplement their Medicare benefits.2 This is a popular choice because Medicare doesn’t cover all medical expenses –
- Medigap pays the deductible – Your Medicare part A deductible is $1,288 in 2016
- Medicare has coverage limits on hospital stays. If you stay in the hospital for more than 61 days, you will have to pay coinsurance of $315 each day thereafter until you reach day 90, where you will face a $644 per day fee.3 No one wants to be faced with potential hospital bills this large. Medigap policies cover Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.4
If you have a Medigap policy like Unity’s Medicare Select, it will help cover your Part A & B deductible as well as your coinsurance costs.
Getting a good health insurance plan is all about finding the right coverage for your unique situation. Shop right now for a health plan in Wisconsin that is right for you.
If you have questions about how to find a quality plan with access to Wisconsin’s #1 hospital*, call our friendly, knowledgeable and helpful customer service staff at 608.644.3430. They will be happy to help you.
*According to 2015-2016 edition of the Best Hospitals guide by U.S. News & World Report