Health Insurance: Which one to Buy?

by Dr. (Mrs.) Omobukola Olaoye | Where you buy your health insurance determine to a larger extent, the cost you pay for your health insurance. It is about demand and supply. If you have health insurance through your employer or union (the group health insurance), you may have the best deal, premium-wise because your employer subsidize your premium.

As of today, November 1st, you can join or change your health insurance plan for next year. As you may know, the plan changes from year to year. Which is why it’s wise to compare your health insurance choices from different companies before you choose one before the deadline of December 15th. The changes you make to your health Insurance plan will not take effect until January 1st next year.

The health insurance terrane is now all about patient choice, (Fotaki, 2013, Marquand, 2018). Which means our choice of health insurance is contingent on our current situation. When it comes to the choice of the most suitable health insurance plan for me and my family or for you and your family, it is about weighing the cost and benefit in our current situation and choosing that which brings us the most value. People tend to choose acts with maximum expected utility, (Maziak and Ward, 2009; Briggs, 2017). That is, informed people tend to behave in their best interest, hence make rational choices.

Therefore, the goal of this article is to provide information that may assist you in choosing the most appropriate individual health insurance plan as we consider renewing our health insurance. Thank God for the growing ease of access to information through various means of communication and information technology, regardless of inequalities of education and income, hence more people can make informed decisions, in this case the choice of the health insurance that best fit our current situation, (Maziak and Ward, 2009).

 Open Enrollment

Open enrollment is upon us, that means a time when one could make changes to one’s health insurance coverage. These changes include, but are not limited to switching plans, adding a coverage or removing unneeded coverage. Prior to 2014, one could purchase health insurance at any time during the year, however, now, one can only buy health insurance during open enrollment, unless one has a special circumstance such as becoming a U.S. citizen, gaining status as a member of an Indian tribe, moving outside one’s insurer’s coverage area, leaving incarceration, getting married or having a baby. Others include losing other health coverage due to divorce, COBRA expiration, job loss, change in income or household status, aging off a parent’s plan, or losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), (Masterson, 2018; Marquand, 2018). One can get Medicaid or CHIP (federal and state insurance programs for low-income families) at any time of year though. Open enrollment typically starts around November and ends in December. However, some States like California, Colorado, D.C., Massachusetts, Minnesota, and New York have varied start and end dates. So, check your State’s begin and end date for enrollment, (Healthcare Markets).

Which Insurance to Buy?

Do you have an opportunity to buy group health insurance from your employer, through your union (Association Health Plan), or do you have to buy your individual health insurance coverage through the exchanges? Where you buy your health insurance determine to a larger extent, the cost you pay for your health insurance. It is about demand and supply. If you have health insurance through your employer or union through the group health insurance, you may have the best deal, premium-wise because your employer subsidize your premium. Often, large corporations can provide affordable health insurance for their employees because of high participation, (McKelvy, 2014; Lankford, 2018). Hence, check with your employer.

If, however, you do not have the opportunity to get health insurance through your employer, that means you may seek to get individual health insurance through either the government insurance exchanges, otherwise referred to as the marketplace (Federal or State) (healthcare.gov), the private insurance exchange (eHealth) or directly from an insurer (The Best Health Insurance Companies:2018).

You may purchase your Medicaid and the Children’s Health Insurance Program (CHIP) plan, if you qualify as a low-income and/or disabled individual, through federal-state Medicaid program, and you may purchase your Medicare plan, if you meet the age requirement of 65 and above, through the Social Security office.

You may be eligible for subsidized premium if your income falls below 400 percent of the federal poverty level (FPL).  For 2019 health plans, the 400 percent threshold is $48,240 for a single person. However, the only way you can take advantage of a premium subsidy is to buy health insurance from the marketplace, (Speights, 2015; Marquand, 2018; Masterson, 2018; healthcare.gov). The good news is that the government-offered premium tax credits is best for low-income adults, however, the higher the income the more the adults pay for premium, regardless of if you have individual coverage or employer coverage, (Collins and Gunja, 2018). As one’s choice is limited to the health insurance options offered by an employer coverage, one is also limited to the available health insurance carriers that choose to participate in the marketplace, where options differ from one state to another within the U.S. (WalletHub, 10 Best and Worst States for Health Insurance Costs as reported in Huffington Post, Kirkham, 2017).

What if you are one of those caught in the coverage gap, with incomes too high for subsidies, or those wedged by the ‘family glitch’, where your employer-sponsored plan becomes unaffordable because you added your dependents? Then short-term health insurance could be an option for you, depending on availability of such plan in your State, (Short-term Health Insurance) which may be purchased on websites such as Healthinsurance.org  eHealth. However, bear in mind that short-term insurance does not cover pre-existing conditions, neither is it a comprehensive coverage, (Norris, 2018).

If you now travel outside the U.S. more often than before and your current plan does not cover you abroad, then you may need to find a plan that covers you internationally (international health insurance plans; Healthcare International; eHealth), or you may need to get travel insurance or supplemental insurance in addition to your current health insurance, (Loffredi, 2015; Travel.State.gov, 2018). If you now have a medical condition that warrant the purchase of medical tourism insurance, then you may explore Medical Tourism Travel Insurance.

 Conclusion

As you sift through all the insurance information for consideration in your current situation, it bores down to which health insurance plan you consider will add value to your family health. What treatment do you need? Is it available and is it affordable? Hence, some people choose to travel outside their country to seek heath treatment (Medical Tourism) because it is the most viable option for them. Do we need short-term, or temporary, health insurance plans outside the open enrollment period? Bear in mind though that these temporary plans provide only limited benefits. What about a managed plan that has a local doctor in a provider network, more flexibility and health coverage that comes with a higher premium, or do you want a plan with lower premiums that comes with a higher-out-of-pocket costs?

The choice is yours. You cannot be declined for an individual health plan, regardless of your health history, and insurance companies cannot charge you more because of your medical conditions. Likewise, health plans cannot cap the amount of your benefits, and they cannot make you pay more than a certain amount out of pocket each year for the health care you receive. Keep in mind, plan categories have nothing to do with quality of care, (Marquand, 2018). So good luck.

References

AARP. Understanding Long-Term Care Insurance. Retrieved from https://www.aarp.org/health/health-insurance/info-06-2012/understanding-long-term-care-insurance.html

ASPE Research Brief (2016). Health plan Choice and premiums in the 2017 Health Insurance Marketplace. Retrieved from https://aspe.hhs.gov/system/files/pdf/212721/2017MarketplaceLandscapeBrief.pdf

ASPE Research Brief (2017). Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange. Retrieved form https://aspe.hhs.gov/system/files/pdf/258456/Landscape_Master2018_1.pdf

Briggs, R. A., “Normative Theories of Rational Choice: Expected Utility”, The Stanford Encyclopedia of Philosophy (Spring 2017 Edition), Edward N. Zalta (ed.), https://plato.stanford.edu/archives/spr2017/entries/rationality-normative-utility.

Collins, S. R. & Gunja, M. Z. (2018). Premium Tax Credits Are the Individual Market’s Stabilizing Force. Retrieved from https://www.commonwealthfund.org/blog/2018/premium-tax-credits-are-individual-markets-stabilizing-force

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