Selecting a health insurance program can be tricky. Knowing just a few things before you compare health insurance plans can make it simpler. There are four categories of health insurance plans such Platinum, Gold, Silver, and Bronze. These plans include different services and pay for them at different levels. Depending on your income, there are cost-sharing reductions like health Health Insurance Subsidies that make them affordable.
More information on these plans is detailed here.
Why do you need health insurance?
Everyone looks for an affordable health insurance plan that can be helpful for them. Medical insurance is a method for getting financial support when you need it the most. Suppose you are jobless, or you are coming up short on employment, then you need medical treatment due to a mishap. With health insurance, you can pay for your treatment and without financial failure.
The ObamaCare / Biden Care Health Insurance Marketplace
The Affordable Care Act (ACA), also known as Obamacare / Biden Care, fixed several loopholes in the health insurance system. They were guaranteeing coverage for all, regardless of the presence of pre-existing conditions.
Plans under the ACA must carry certain forms of health coverage:
- Emergency health services
- Prescription drugs
- Ambulatory (non-overnight) hospital services
- Laboratory services
- Pediatric medical services
- Pediatric services (for children), including dental and vision care
- Maternity care
- Mental health services
- Substance abuse services
- Preventative medicine
- Wellness/chronic disease management
- Rehabilitative care and devices
Medicare advantage plan
The AFFORDABLE CARE ACT also ensures that Seniors (i.e., citizens aged 65 and over) and specific groups with defined life-limiting conditions at any age can be assured of the life-sustaining medical and care support they need.
Medicare for all explained (parts A, B, C, and D)
1.) Medicare PART A
Essential hospital services
If you or your spouse have paid Medicare taxes for ten or more years, your Medicare Part A is premium free. Medicare Part A covers:
- Emergency care
- Skilled nursing
- Hospice care
- Home health services
The deductible is $1316. Free hospital stays and skilled nursing facilities are limited to 60 and 20 days respectively and after that on a sliding scale.
If you have an incomplete record of Medicare taxes, your premium will be between $225-$415 pm.
2.) Medicare PART B
Essential Doctor’s and medical costs
- Visits to Doctor’s office
- Laboratory services
- Medical equipment
- Mental health services
- Outpatient and ambulatory (walk-in) services
Medicare Part B is a contributory plan. The standard premium (2020) is approximately $140 pm (but may be higher depending on income). You will pay less if you receive Social Security benefits. The average monthly payment is less than $110.
The deductible, i.e., the bills you pay in full before your plan comes into action, will be less than $200 (each contract period).
Your insurer will cause 80% of further allowable expenses.
Sounds good: Medicare Plans A+B cover the essentials
But, if a long-term hospital stay occurs or an extended need for medication, prescription drugs, or skilled nursing, you could face life-challenging costs.
The ACA (Obamacare) provides both security and choice.
Security comes from the Federal and State commitment to underwriting the cost of primary medical and health care. Health exchanges ensure there is competition between both insurers and provider networks.
The choice comes from the options to build on the ACA foundations to meet individual circumstances.
3.) Medicare Part C (aka Medicare Advantage)
Depending on your additional choices, a Medicare Advantage Plan / Medicare Part C combines your Medicare A & Medicare B plans (at a lower premium!) and allows you to add protection according to your specific needs.
Medicare advantage plan may cost nothing but, depending on your choices, can provide the additional security you need for as little as $100 pm.
There are limitations to the medicare advantage plan
- You can only use ‘in-network’ doctors, hospitals, and referred specialists
- Coverage will be restricted to your local area
- Costs and coverage may change at renewal
But you do have options to change during the appropriate enrollment periods.
4.) Medicare supplements plan
Without losing the benefits of ACA (Obamacare / Biden Care), you can use medicare supplementary insurance to
- Reduce or eliminate your out of pocket expenses
- Give yourself a wider choice of doctors, hospitals, and specialists
- Be certain of medical coverage when you travel
Once agreed, the coverage is guaranteed and the costs fixed during the lifetime of the policy.
You can add ‘prescription’ drugs (Medicare Part D) to any combination of plans which include Medicare Part A, or automatically through your choice of Medicare Advantage Plan.
If you anticipate the immediate or long-term need for prescription drugs, discuss your circumstances with your Doctor.
The average monthly premium cost is about $35 pm but might be considerably higher depending on your choice of branded or generic drugs.
Contact the exchange of your choice. Even if you start ‘on-line,’ select the Medicare plan(s) that best reflect your needs and circumstances and discuss them with a qualified advisor. Most private exchanges (like TrueCoverage) will call you back to give free, unbiased advice.
The exchanges’ role is to ensure that you have informed access to fair value health insurance coverage.
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