Preparing to Shop for a Health Plan

Plans with an effective date of January 1st, 2014 or later will not have medical underwriting.

There is now more of a focus on the consumer's ability to pay for the coverage.  It will be important to know your household "size" (number of dependents) and the household "income" (income for all individuals included on your tax return).

If you want to take advantage of a subsidy, then you must agree to file your taxes by April 15th and to file jointly if married.

Common Health Insurance Terms

Coinsurance:  The percentage that you pay after meeting your annual deductible.  The insurance company will pay the rest.

Co-payment:  A fixed dollar amount that you pay when you for a doctor's office visit or to get a prescription.  This is collected at the time of service.

Deductible-Brand Name: The amount that you pay each year before your health plan starts paying towards the cost of your brand name medication.

Deductible- Individual:  The total amount that an individual pays prior to the health insurance paying towards the cost of medical services.  The higher the deductible, the lower the monthly premium.

Deductible- Family:  This applies when there are two or more family members on the plan. 

In-network:  A group of doctors and hospitals that participate in the insurance carrier's network.  It is important to check on the insurance company's website or with the medical provider to make sure that they are "in-network" so ensure that you get the negotiated rates.

Out-of-network:  Any health care provider that is not participating in the insurance carrier's network.  You will pay more out of pocket with an out-of-network provider.

Out-of-pocket maximum:  The most you will have to pay per year for covered health expenses before the insurance company will pay 100% for the rest of that year.