Are you about to turn 26? Feeling anxious about leaving the comfort of your parent’s health plan? Take a deep breath. You have choices, and there is a lot of information at your fingertips to help you figure out what you need.
Health insurance may seem overwhelming, but when you break it down to the essential elements you need in order to take care of your health, it’s much more manageable. To help get you started, we’ve outlined some key tips and guidelines below. Think of them as bite-sized pieces of insurance information that you can slowly digest.
If your employer offers insurance
First, if you’re employed and your employer offers health care coverage, it would be wise to consider getting on their plan. If you’re a little fuzzy on the ins and outs of health care coverage, talk to someone in your employer’s human resources department. You’ll want to know:
- The premium cost
How much comes out of your paycheck to pay for insurance?
- Your out-of-pocket expenses
This means deductible, copayments and coinsurance – anything that you pay for outside of the premium.
- The benefits
Does the plan cover benefits like vision, prescriptions, acupuncture or mental health?
- If your current provider is in-network
In other words, does your current doctor accept the insurance offered by your employer? (If not, you may have to pay a higher rate or out-of-pocket.)
Options for independent plans
If your employer doesn’t offer health care coverage or if you decide their plan isn’t right for you, or if you’re self-employed, you may want to shop in the Health Insurance Marketplace. If your state doesn’t have one, you can go to the federal marketplace. Visit healthcare.gov to create an account and start looking at plans. Be sure to look at premium costs, out-of-pocket expenses, benefits, and which providers and specialists are in the network.
See if you qualify for financial help through the exchange. If so, you’ll receive a discount on the premium based on your household income and family size.
Another way to shop for a health plan is by using an online resource, such as eHealth Insurance Services. The site offers useful information about types of insurance and plans, costs, plus tons of resources. For example, there’s a section devoted to insurance terminology. This is incredibly helpful—most insurance language can start to look like word soup.
You also might consider talking to an insurance broker or agent. Their services are free – yes, free – so you can ask them a million questions about health plans. You’ll find a broker or agent in your area by doing a search online, but the best approach is to ask for a referral from family or friends.
How do you decide what to buy?
Before you start shopping for a health plan, whether it’s through the health care marketplace, a private exchange or directly from an insurer, you should gauge what your health care needs will be in the year ahead.
Do you pursue risky sports, such as skiing or mountain climbing? Take that into consideration. Do you have a chronic health condition, such as asthma or diabetes, which requires management? Do you take a prescription or foresee needing a medical treatment?
Look at monthly premiums and deductibles. The higher the deductible, the lower the monthly premium. That may be appealing; however, it means that if anything catastrophic happens or if you require a lot of health care in a year, you will have to cover the entire deductible with money out of your pocket before the insurance kicks in.
If benefits are really important to you, make a list. Do you want acupuncture or chiropractic care covered? If you do, then consider a plan that covers alternative care. Do you need vision covered? Look for a plan that includes vision. (You can also purchase separate plans for both vision and dental.)
And if you and your sweetheart are planning to tie the knot soon and want to start a family right away, don’t ignore maternity. Although it’s considered an essential health care benefit and therefore covered, the deductible and services vary among insurers.
For expert input on this complex topic, we sought the advice of Karla Pollich, marketing manager at Providence Health Plan in Portland, Ore. If you want to include Providence Health Plan in your search, find out more by visiting their website.
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