Health Insurance Provider Review
How Do I Find Affordable Medical Insurance?
The top performers in our review are Blue Cross Blue Shield, the Gold Award winner; Humana, the Silver Award winner; and Kaiser Permanente, the Bronze Award winner. Here’s more on choosing coverage to meet your needs, along with detail on how we arrived at our ranking of seven major insurance companies.
Health insurance is now available to more Americans than ever before. Subsidized options are easily available to low-income individuals and families. In the past, many people took the risk of not being insured, but with the Affordable Care Act (ACA) you can be fined if you don't have qualified health care insurance. Instead of paying a fine, people who have not been able to afford insurance before are looking for affordable medical insurance options.
While some may be asking themselves if it would it be cheaper to just pay the fine, statistics show that more Americans have health insurance now than before the ACA was enacted. There are several reasons why more people have insurance now, but one is certainly the increase in affordable health plan options, including subsidized, or tax credits, health insurance purchased through one of the state exchanges. Compliant insurance can also be purchased privately. The options available to you depend primarily on your income level.
Low Income: If your income is 100 to 400 percent of the national poverty rate ($11,490 - $45,960) for a single person, you may qualify for subsidized health insurance. In many cases this is not free health insurance but subsidized. This means you can get bronze-level health insurance for about $2570 per year through one of the state exchanges. Extremely low-income individuals and elderly persons often qualify for Medicare. If you paid the fine for 2014 you may still qualify for insurance via an exchange, even if it is not during the open-enrollment period, to avoid the fee in 2015.
Best Options for Low-Income Earners: Medicare, state exchange or fine exemption
Middle Income: If your income is above the threshold of $45,960 (adjusted), you will not qualify for subsidized health insurance. Those above the poverty rate can still shop for insurance via an exchange but will not benefit from subsidies. However, income thresholds change depending on household size, so it is worth finding out if you qualify. Individuals can also shop for insurance through one of the major carriers, including those listed in this review, such as Humana, Kaiser Permanente or Blue Cross Blue Shield (BCBS), depending on what is available in your area. In most cases you can expect to pay about $300 to $600 per month in premiums for individual insurance. If you don't know if your income qualifies for subsidies, you can use one of the exchange calculators to help you figure that out. Another option for healthy mid-income individuals is high-deductible health plans. These plans have a deductible of up to $6,600, but will have a lower monthly premium and will help you pay major expenses.
Best Options for Mid-Income: Individual health insurance (lowest-option) or high-deductible health plans.
High Income: Those with a high income are facing a different problem. Many who have high incomes didn't purchase insurance in the past; they just paid health care expenses as needed. Paying two percent of a high income for the penalty can be a rather large sum for high-income persons. In this case, it might be cheaper to just buy qualifying health insurance. If you are in good health, you might want to choose the lowest qualifying plan. If you have ongoing health issues, you may as well bite the bullet and choose a more exhaustive plan and lower your out-of-pocket expenses.
Best Options for High-Income: A low-cost qualifying plan for healthy people or more comprehensive plan for those with larger health expenses.
Key Numbers to Consider:
Average bronze-level health insurance plan: $2,570 per year for individual insurance.
Shared responsibility payment: $325 per adult and $162.50 per child (up to $975 for a family), or 2 percent of your household income, above the tax return filing threshold for your filing status – whichever is greater.
Cost of non-subsidized, individual health insurance: $300 - $600 per month, or $3,600 - $7,200 per year.
How We Evaluated Health Insurance Companies
Evaluating health insurance companies for every person's needs is impossible. Plan pricing can vary greatly depending on your exact circumstances. However, we collected data to help us determine the selection of plans available and average premium rates for the companies we reviewed. We rated the companies highest that provide a wide range of plan options coupled with competitive pricing. We researched the least and most expensive plan options for metropolitan and midsize town locations across the U.S. for 35, 45 and 55-year-old non-smoking males. Using this data we were able to determine which service generally offers the widest range of plan options at a reasonable price. The quotes you receive might vary greatly from our test data depending on your specific situation.
Health insurance pricing varies depending on age, location, gender and many other factors. To find the best health insurance plan for you, we recommend obtaining quotes from at least three different companies.
How Do I Obtain a Health Insurance Quote?
If your employer does not offer an affordable health insurance option and you do not qualify for subsidized insurance or Medicare, you can shop the open market for medical insurance. The health insurance companies we reviewed will allow you to request a quote online rather easily. Premium rates vary significantly by multiple factors. You'll learn that the monthly rates increase quite a bit as you age. Smoking also increases the premium rate. In most cases you can select non-smoking if you have not smoked in over six months.
Services such as eHealthInsurance are simple to use and provide a variety of quotes but may not always show every option available. You may find more plan options by requesting plan information directly from the insurance company's website. Before purchasing new insurance it is always a good idea to ensure that your preferred doctor accepts the insurance you are looking to purchase. While your doctor may be listed on the insurance company's website, it is smart to call your doctor's office directly to verify.
Even if the open-enrollment period has passed for signing up for insurance via one of the exchanges, you might still be able to purchase subsidized insurance if you've had a qualifying life event. Qualifying events include moving to a new state, change in income, change in family, loss of coverage and others. You may even be able to apply simply because you did not understand that open-enrollment ended or you did not understand the health care law. If your income qualifies you for subsidized health care, you'll want to purchase through your state exchange.
To learn more about health insurance in general see our articles about health insurance.
Considerations for Comparing Health Insurance Plans
Plans vary greatly. But the general rule of thumb is that the less you pay per month, the higher your deductible is. Higher premiums are usually associated with lower deductibles. Generally it is beneficial for those with existing health issues to opt to pay more per month and less out-of-pocket for services. Those in good health often opt for a high deductible option in hopes that they never have to actually pay the deductible but would mostly be covered if something major happened. A prescription plan is another important consideration. If you need to take medications regularly you'll want to choose a plan with a good prescription plan. If you need to insure your entire family, you'll want to look at family deductibles and maximums. Only full-coverage options will satisfy the minimal essential health care insurance required to get around paying the fine.
Major Points to Compare:
This is your monthly payment for health insurance. It may be worth asking if you can get discounts for paying in advance or if you set up direct payments from your bank account.
The amount you are required to pay, not counting preventive care, before the insurance company starts paying out. Low-deductible plans offer deductibles of about $500, whereas high-deductible plans might be as much as $6600.
This is the maximum you'll have to pay out-of-pocket. Sometimes this is more than the deductible. It is not uncommon to have a deductible of $1200 and a maximum out-of-pocket limit of $1500. This of course does not count your premiums.
Preventive Care Covered
Most insurance policies now cover preventive-care visits 100 percent. However, some may limit the number of checkups or how often certain procedures such as mammograms are covered.
If you need to take maintenance medications you'll want to find an insurance plan with an above-average prescription plan. You should check to see if it covers the medications you are currently taking satisfactorily or if it covers suitable generics.
In-Network vs. Out-of-Network Coverage
While in-network providers are discounted, you usually pay significantly more for out-of-network health care. This is a good reason to contact your primary doctors to ensure they are preferred providers.
Types of Plans Available
While looking for insurance you many notice a wide variety of plans. Some may provide coverage for a large selection of doctors whereas others may provide increased coverage to preferred providers.
Here are the most common insurance types explained:
Preferred Provider Organization (PPO)
This type of insurance provides better coverage to providers within their network. Usually the insurance company and the provider have agreed in advance to the billing costs for common procedures. Out-of-network providers, or those without an agreement, might not be covered or will cost the patient more out-of-pocket.
Health Maintenance Organization (HMO)
With an HMO plan, you have to work with one primary doctor and all additional procedures or testing is routed through them. You have to have a referral from your primary doctor before seeing a specialist unless it is an emergency situation.
Exclusive Provider Organization (EPO)
This type of plan limits the network of doctors and hospitals covered in order to help control costs. Out-of-network doctors and hospitals are not covered at all.
Point of Service (POS)
These types of plans are a mixture of HMO and PPO. You would need to use a primary doctor to coordinate your care, but there is more freedom to visit the health care provider of your choosing. If you visit a provider outside of the network, you have to pay the bill and then submit a claim to the insurance company for partial reimbursement.
High-Deductible Health Plan (HDHP)
These types of plans usually have lower monthly premiums but higher deductibles. In many cases the deductible is $6,600.
Flexible Spending & Health Savings Accounts
These are not insurance plans, but ways of assisting with medical costs with pre-tax money. Often these accompany a high-deductible plan in order to help cover the high deductible easier. Flexible spending accounts are often use-it-or-lose-it, but health savings accounts typically can roll over to the next year.
Short-term medical plans are designed to fill the gap between insurance coverage. So if you are going to be changing jobs, for example, and might have a gap before your new insurance takes over, short-term might help you.
Non-Compliant Options to Consider
If you decide to opt out instead of acquiring compliant health insurance, you do have a few options. These options probably won't qualify to relieve you of having to pay the shared responsibility payment, but they can still lower your health care costs. Many insurance companies offer short-term insurance plans that might help you between coverage periods or after losing insurance. Catastrophic insurance usually has a high deductible, but can help if you need expensive treatment. Another option is Direct Primary Care (DPC) or "concierge medicine." These are not standard insurance models but involve a direct payment to the provider as an annual fee or retainer for services. This type of arrangement is not common, but it's an option for some. Boutique offices are becoming increasingly popular as well. These medical practices do not bother with insurance and simply make cash-price arrangements with patients. Many offer quite competitive rates for routine services. However, keep in mind that this alternative option does not satisfy the requirement to have minimal compliant health insurance and that you may need to pay the fine unless you are somehow otherwise exempt.
While obtaining suitable health insurance requires a bit of effort, health insurance is now affordable to more Americans than before. Increasing the parental coverage to 26 years old and introducing the medical exchanges has helped, especially for younger Americans who can now acquire affordable coverage. It only takes a few minutes using our health insurance tools to discover the plans available in your area. To find the best plan for your specific needs, we recommend comparing plans from at least three insurance companies that offer coverage in your area.