Get Value out of Your Individual or Family Health Insurance
The decisions you make during open enrollment have an impact on your healthcare throughout the following year. Arizona Care Network can help you navigate the often-confusing healthcare industry. We want you to be informed and stay healthy. One way we can best assist you is by providing the health insurance information you need to make a smart decision when it…
The decisions you make during open enrollment have an impact on your healthcare throughout the following year. Arizona Care Network can help you navigate the often-confusing healthcare industry. We want you to be informed and stay healthy. One way we can best assist you is by providing the health insurance information you need to make a smart decision when it comes time for open enrollment.
According to the U.S. Census Bureau’s 2013-2017 American Community Survey, an estimated 9.57% people in the United States are uninsured.
Many people have access to health insurance through their employer and that is usually the most cost-efficient option. Individual and Family Plans are an excellent health insurance option for people who are:
- In between jobs
- Self-employed
- Working part-time
- Looking for family coverage
- Do not get healthcare insurance through their employer
When considering your coverage options, you will want to keep three main things in mind to ensure you choose the right plan for you and your family.
1) Provider Networks
You will be able to choose from HMO and PPO plans. The differences are listed below:
- HMOs: A model with a defined network of doctors. As long as you stay in network, you don’t need a referral to see specialists who are in network and you’ll be charged the lower, in-network rate. This helps you manage your healthcare costs. This option is usually less expensive than a PPO.
- PPOs: Gives you the freedom to see any doctor or specialist, but this broader access comes at a higher cost.
If you have children, make sure the plan’s network includes pediatricians, pediatric specialists and a children’s hospital. If you or your family members see different specialists often, you will want to choose a plan that has a variety of in-network doctors and specialists close to your home.
2) Insurance Plan Benefits
All individual and family plans are required by law to include Essential Health Benefits. Essential Health Benefits fall under 10 categories:
- Ambulatory patient services (outpatient services)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (that help patients acquire, maintain, or improve necessary skills for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Source: Familiesusa.org, 2018
Many individual and family plans come with added benefits such as:
- No referrals
- 24/7 nurse lines
- Same-day/ after-hours appointments
- Care Navigator support
- Cash rewards programs
- Online bill pay and online scheduling
- Appointment wait-time notifications
- Text reminders
- Health coaching
- In-home care
- Medication adherence programs
Based on your family’s needs, some of these added benefits may be necessary. If that is the case, you will want to compare different plan options to see what additional benefits are included.
3) Cost of Insurance
Individual and family plans are likely to cost more than employee-based plans, but less than COBRA. The first thing you will want to consider when choosing a plan is out-of-pocket costs.
The average annual premium (amount paid for the actual insurance policy) for individual health plans is about $7,200 according to Insure.com. Family plans will cost more, and averages will vary from state to state. Depending on your income, you may qualify for tax credits through the IRS and funding from the Affordable Care Act that reduces your out-of-pocket costs.
Other costs you will want to consider:
- Deductibles: The amount of money you will have to pay before the insurance company will pay for a claim
- Copays: The amount of money you will pay for a specific healthcare service
- Co-insurance: The percentage you will pay for covered healthcare services vs. the percentage the insurance company will pay for (typically ranges from 20 to 60 percent)
Note: We know choosing an individual or family healthcare plan can be confusing and stressful. Arizona Care Network is the care partner (provider network) for Bright Health’s Individual and Family Plans in Arizona. If you’d like more information on how ACN and Bright Health are working together to improve the health of our members and reduce costs, visit BrightHealthPlan.com.