Critical Illness: 10 Things to Consider When Choosing Medical Insurance Plans

Open enrollment on for 2015 health insurance ends on February 15. Here's what you need to know to find the best plan for your family.

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Health insurance under Obamacare is in its second year and millions of Americans are heading back to to update their plans during open enrollment. Even if you’re satisfied with your existing plan, the White House is encouraging everyone who signed up through the Marketplace to take another look at the new options.  Now that the Affordable Care Act is well underway and the kinks have been worked out on, it’s the perfect time to take a second look at what is available through the Marketplace to find out what policy is best for your critical illness insurance needs.

This is especially good news for the increasing number of self-employed workers out there. Christine Barber, a senior policy analyst at Community Catalyst, a health care advocacy organization tells U.S. News: “The ability to buy insurance in the individual marketplace and qualify for tax credits has really opened up more opportunities for people to be self-employed and entrepreneurs.” To help you make an informed decision, here are 10 things to consider when choosing health insurance.

1. Doctors

Critical Illness: 10 Things to Consider When Choosing Medical Insurance Plans

If you have a doctor, or doctors, that you have a good relationship with, make sure to find out what plans they accept. You can usually check the list of providers for each plan when you enroll on the website. You can also call your physician to find out what plans their office will be accepting in 2015. The Marketplace has a page of tools for comparing care providers and hospitals.

2. Hospitals

The same goes for hospitals and health centers. If you have a preferred hospital, make sure they are participating with your chosen health insurance provider before making your final decision.

3. Prescriptions

Critical Illness: 10 Things to Consider When Choosing Medical Insurance Plans

If you are taking any expensive prescription medication, it’s important to compare prescription benefits for each plan and make sure your medications are covered.

4. Tax Subsidy

Depending on your annual income, you may qualify for a tax subsidy to cover part of your insurance premiums. If so, you’ll have the option to apply it toward your monthly premiums up front or receive it as a refund at the end of the year.

5. Deductibles

Critical Illness: 10 Things to Consider When Choosing Medical Insurance Plans

A deductible is the amount of money you have to pay out-of-pocket before your insurance coverage kicks in. High deductible plans generally have lower monthly premiums, while low deductible plans have higher premiums. Unless you have a savings cushion to cover the cost of your deductible in the event you get sick, it’s best to find a policy with the lowest deductible combined with a monthly premium you can afford. If you know you’re going to have a lot of medical bills, it’s usually worth paying a higher monthly premium to get the lower deductible.

6. Copays

Copays are another important consideration when choosing health insurance. The copay is the amount you may have to pay for prescriptions, appointments and other health care after you’ve met the deductible. It’s usually a flat dollar amount or a percentage of the cost of the service.

7. Out-of-Pocket Limit


Finally, the out-of-pocket limit is the maximum annual or lifetime amount that you will have pay for healthcare. Once you’ve met that limit, everything will be covered by insurance. So, like deductibles, that number tends to be higher with lower premiums and vice versa.

8. HSA

High deductible plans allow you to qualify for a Health Savings Account, or HSA. According to NerdWallet, “For 2015, the IRS defines an HDHP for an individual as a plan with an out-of-pocket maximum of $6,450 and a minimum deductible of $1,300. For a family plan in 2015, the out-of-pocket maximum is $12,900 and the minimum deductible is $2,600.” An HSA lets you set aside a certain amount of pre-tax income to use for medical expenses.

9. Benefits


One of the best aspects of Obamacare, besides banishing pre-existing conditions, is that all policies are required to cover essential benefits like wellness visits and mammograms. Different plans offer a variety of other benefits (dental, mental health, pregnancy, etc.) that you may want to look into.

10. Catastrophic

As the name suggests, catastrophic insurance is designed to cover only extremely high, unexpected medical expenses. They have very high deductibles, low monthly premiums and generally don’t cover any medical care until the deductible has been met. The ultimate goal of the Affordable Care Act is to eliminate these policies as everyone gets comprehensive health insurance. Currently, only those under 30-years of age or people with hardship exemptions may purchase these policies.

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