Aside from opening the health insurance market to everyone, and helping us all to afford a healthcare plan, a large part of the Affordable Care Act was aimed at regulating the health insurance market itself. Providers are required to meet certain standards, helping to ensure that everyone can access a quality healthcare plan.
While these changes are overwhelmingly positive, increased regulation means the introduction of new terminology. And that’s where some consumers get confused. So what do you need to know, before navigating the health insurance marketplace?
First of all, the Individual Mandate part of the ACA does indeed require most Americans to enroll in a healthcare plan. Otherwise, you could face a penalty on your taxes in the spring. However, don’t just rush out and enroll in any old health insurance policy! Since you’re spending money on this plan anyway, take the time to evaluate your needs and choose a plan that provides real value for you and your family.
The second thing you should know is that healthcare plans are divided into “tiers” according to cost and value. These tiers – Platinum, Gold, Silver, and Bronze – are standardized, so that each plan in a particular tier offers the same benefits. But that does not mean the plans are all identical. Premiums, coverage for prescription drugs, and provider networks can vary from one plan to the next, even within the same tier.
That means consumers can’t simply decide which tier of plan is right for them, select a policy at random, and enroll. In particular, provider networks provide a challenge here in California, due to shortages of providers and facilities in some areas. A health insurance plan that works well for someone of your same age, health status, and income in one part of the state might not suit your needs where you live.
What does this all mean? It means that when you look at a health insurance plan on paper, you might be tempted to base your decision upon factors like the deductible and premium costs. Those are important considerations, but a bit more detective work is required, in order to ensure that your plan will be a good fit for you. Be sure to investigate prescription drug coverage, particularly if you need any particular medications on a regular basis, and inquire about covered physicians and facilities in your area. You want to make sure you can continue seeing your regular doctor, access necessary specialists in the area, and receive care in quality facilities near your home.
As you can see, the selection process for a quality health insurance plan is more complicated than it appears on the outside. As Open Enrollment season approaches, remember to contact us with any questions you might have about health insurance coverage. We can help you select a plan that both suits your budget and provides real value to you and your family.