What to look for in a health insurance plan
All health insurance plans are different. Each plan helps you pay for medical care. But each plan covers different things and costs a different amount of money.
The Affordable Care Act (also called the ACA or Obamacare) gives Americans new choices for health insurance. When picking your plan, take some time to think about the medical needs you expect for you and your family in the next year. Then compare plans to find out which one is right for you.
You can find out about different health insurance choices through the Health Insurance Marketplace (also called the Health Insurance Exchange). This is an online resource that helps you find, compare and buy health plans in your state. For each plan, you may want to compare how much it costs to you and what providers, services and prescriptions it pays for.
How do you know what a health plan costs?
When comparing health insurance, look at these costs to help you decide if the plan is right for you:
- Premium. This is the amount of money you pay each month for insurance.
- Deductible. This is the amount of money you have to spend before the plan starts paying for your health care. For example, if you have a $500 deductible, you have to spend $500 on health care before your plan will pay. Your deductible does not include your premium.
- Co-payment (also called co-pay). This is the amount of money you pay for each health care service, like a visit to a health care provider.
- Maximum out-of-pocket cost or expense. This is the highest amount of money you would have to pay each year for health care services. You don’t have to pay more than this amount, even if the services you need cost more.
You can find out about each health plan’s costs in the online Marketplace. To see more terms and definitions that insurance plans often use, go to: www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf
What health care providers do insurance plans cover?
Each health plan has a network (group) of health care providers, including doctors and hospitals. Here’s what to look for in a health plan when you’re thinking about providers:
- Preferred providers. These providers have a contract (agreement) with a health plan to provide medical services to you at a discount. In many cases, going to a preferred provider is the least expensive way to get health care.
- Participating providers. These are preferred providers, but they may be more expensive to see.
- Tiered network. This means a health plan has different costs for different providers. You may have to pay more to see some providers than others.
If you or a family member already has a health care provider and you want to keep seeing him, you can find out which plans include that provider. You can still go to that provider even if he’s not covered by your plan, but you may have to pay more to see him. Or if you’re pregnant and want to have your baby at a certain hospital, you can see what plans include that hospital.
You can find out about each health plan’s providers in the online Marketplace.
What health care services do insurance plans cover?
Each health plan covers certain health care services, like doctor visits and hospital stays. The ACA requires all plans to cover most basic health services. But plans may not cover all services, or they may limit the number of visits or services you can get.
If you have a medical condition that needs a certain kind of care, look at each plan to make sure that the care you need is covered. You can find out what services are covered by each health plan in the online Marketplace.
Does health insurance cover prescriptions?
All plans have to cover prescriptions, but each plan covers them differently. A prescription is an order for medicine given by a health care provider. If you use prescription medicine, you can check to see which plans cover it.
You can find out what prescriptions are covered by each health plan in the online Marketplace.
Frequently Asked Questions
What is happening with health care reform?
While some provisions take effect this September (see our In-depth article), the new law will not fully go into effect until 2014. In the interim, the March of Dimes is reviewing and commenting on the rules for implementation that are being issued by the Administration.
The March of Dimes will update this site on items that directly affect women of childbearing age, infants and children, but to get even more information about all of the advances, visit http://www.healthcare.gov/.
Where can I find out about getting insurance coverage for my child?
The first place to inquire is with your state insurance commissioner's office. The U.S. Department of Health and Human Services also has a Web site to help parents determine if their children are eligible for free or low-cost health coverage under the reauthorized Children's Health Insurance Program. Visit http://www.insurekidsnow.gov/ for more information.
Why did the March of Dimes support health care reform?
Since our founding, the March of Dimes has worked to shape public policy that affects maternal and child health. Health reform offered an unparalleled opportunity to improve the health of and address the needs of women, infants and children. Specifically:
- Expanding and improving coverage for maternity and pediatric care
- Strengthening Medicaid (which covers more than 40% of all births)
- Increasing the number of currently uninsured women of childbearing age and children who will be covered in 2014
By law and longstanding tradition, the March of Dimes is strictly nonpartisan and remained nonpartisan throughout the debate. Initially, we worked with members with many different views and party affiliations, but as the debate went on, we focused our energies on ensuring that legislation likely to be approved contained the strongest provisions possible to address the unique health needs of children and pregnant women.