A health insurance plan is a contract between you or your family and a private or public insurer. It pays most medical and surgical expenses, and some preventive care in exchange for monthly premiums you pay. It also covers some of your out-of-pocket costs, up to a set limit. Most individual and family plans have a network of providers with which they agree to accept lower rates in return for enrollees using their services. This is called a provider network, and most plans have either open or closed networks.
Health insurance is available for individuals through the marketplace and privately, and it’s mandatory for those who don’t have other coverage or meet special criteria (like being pregnant) through Medicare and children’s health insurance programs. State and federal regulators oversee plans to ensure they meet minimum standards for protections and benefits.
The most important feature of a health insurance policy is the scope of its coverage. Look for a plan that has coverage for the types of medical events you’re most likely to experience, such as accidents or illness. Also, consider a plan that offers value-added benefits like annual wellness visits or sum insured restoration.
You’ll need to understand how a plan’s deductible and coinsurance work before you can compare costs between plans. Most insurance ID cards clearly show these amounts. A deductible is the amount you must pay out-of-pocket before your plan starts to cover claims. Once you reach your deductible, the plan will typically start paying a percentage of the cost for each eligible claim, while you pay a fixed amount known as a co-pay. The majority of preventive care is 100% covered by most health insurance plans.
In addition to coverage benefits, a good health insurance policy should also have competitive pricing and reliable customer service. It’s worth asking insurers about their ratings with the National Association of Insurance Commissioners, which is an independent agency that investigates complaints. Look for an insurer with a high no-claim bonus, low NAIC complaint index and strong customer satisfaction ratings.
The type of health insurance plan you need depends on your particular circumstances and budget. Generally, market-based plans are organized by the Affordable Care Act into 4 categories (or “metal levels”): Bronze, Silver, Gold and Platinum. There’s also a fifth category, Catastrophic, that’s available for people under 30 and those with qualifying incomes.
If you’re considering a market-based plan, look for an insurer that has a track record of offering competitive pricing and quality customer service. Aetna is one example of a financially-strong, well-rated insurance company that offers an array of marketplace plans. It also has a comprehensive suite of health and wellness programs, including eight medical management programs for common conditions like asthma or depression. These programs can help you keep your health under control and may even save you money on premiums. You can learn more about Aetna’s marketplace plans here. If you’re shopping for a market-based plan, you can use Venteur to quickly compare prices and networks between plans.