IS THERE A WAY TO DETERMINE THE MOST AFFORDABLE HEALTH CARE INSURANCE PLAN IN WISCONSIN?
The short answer is no. The most affordable health insurance coverage for you depends on your situation. A good way to approach this question is to think about the entire cost of coverage – both the cost to have coverage (the premium) and the costs you pay when you use health care (out-of-pocket costs).
Out-of-pocket costs include copays (generally a set fee you pay at the time you use a health care service), coinsurance (a set percentage of the cost of a health care service that you pay), and the deductible (what you pay before your health insurance plan begins to pay).
Each year, more and more people are selecting options that offer lower health insurance premiums in exchange for high deductibles. In a recent survey of privately insured adults, 40 percent said they would prefer to trade lower premiums for higher out-of-pocket costs.
High Deductible Health Plans (HDHP) combined with a Health Savings Account (HSA)
Surprisingly, many people find that an affordable health insurance choice may be a high deductible plan combined with a health savings account. In these plans, health insurance doesn’t pay anything until the deductible is reached. In 2016, that deductible must be at least $1,300 with a maximum out-of-pocket cost of $6,550 for self-only coverage. For family / spouse coverage, the minimum deductible is $2,600 with a maximum out-of-pocket of $13,100 for family / spouse coverage.3 This amount doesn’t include the premiums and costs for any out-of-network health care services. This doesn’t sound very affordable, but other aspects of the HDHP plans make them attractive for some people.
Choosing a HDHP plan often makes sense when combined with a Health Savings Account. The money you deposit into the HSA accrues interest tax-free and you may claim a tax deduction for contributions you make to your HSA. However, the government limits how much you may put in the HSA every year. In 2016, the amount you may save in the HSA is $3,350 for a single person and $6,750 for spouse / families.
A HDHP with a HSA may be a good way to save for health expenses while reducing your taxes. Because you don’t have to spend all the money in the HSA every year, you may build up savings. This money may be used to cover your premiums and deductibles. In addition, you may use HSA funds to cover many other expenses such as eyeglasses and contacts, hearing aids, services such as acupuncture and certain dental care.
HDHP with HSAs may be the most appropriate option, depending on your situation.
ANOTHER REASON HDHP AND HSAS MAY BE THE MOST APPROPRIATE HEALTH COVERAGE
Qualified HDHP plans cover essential health benefits and preventive services as specified by the Affordable Care Act. This means that for some services, you don’t need to meet the deductible before insurance pays the cost. For example, certain preventive care services will be provided at no out-of-pocket cost to you when you visit an in-network provider
OTHER AFFORDABLE HEALTH INSURANCE PLANS
The Affordable Care Act (ACA) provides ways that can help individuals and families buy health insurance through the Health Insurance Marketplace. If you qualify, you may receive “Advanced Premium Tax Credits” that help pay your premiums, or help with out-of-pocket medical costs with a Cost Sharing Reduction Plan. Learn more about these options to help make health insurance plans affordable.
In Wisconsin, some people may qualify for BadgerCare Plus, which is the state’s version of Medicaid. This program offers free or low-cost health care coverage to people under 19, families and pregnant women. This program helps those with low incomes and people who meet specified requirements.
Depending on where you live in Wisconsin, you may qualify for other programs that help make health insurance plans affordable. Contact the Wisconsin Department of Health Services, the Dane County United Way or regional or local organizations.
The most affordable health care insurance plan for you depends on your unique circumstances.