What to Consider When Choosing Health Insurance

Choosing health care coverage is an important decision, and understanding your options and needs can make the process easier.

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First, determine what types of coverage are available to you. Do you qualify for Medicaid, Medicare, VA benefits, TRICARE, or perhaps you have health insurance coverage available through your employer? Some people have multiple options open to them, while others may have only one. Fortunately, with the passage of the Affordable Care Act in 2010, the Marketplace was created to provide health care coverage available for people who don’t have other choices. Kentucky's Marketplace is kynect.

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Next, think about who in your household needs health care coverage. Is it just you, or do your spouse and children need to be insured as well?

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Consider your health and the health of those in your household. How likely is it that you, or they, will need medical care during the plan year? Do you or any family members have chronic health conditions or take regular medications? Is anyone experiencing medical or mental health symptoms that may need evaluation and/or treatment? If so, these factors may affect your total annual health care costs.

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Another thing to take into account is whether you’ll need care outside of the area in which you live.

You will want to find out if you are eligible for a Flexible Spending Account, or FSA, a Health Savings Account, or HSA, or a Health Reimbursement Arrangement, or HRA. These are special programs that let you save money tax-free for qualified health care expenses. FSAs and HRAs are only available through employers. However, HSAs can be used with certain employer sponsored OR Marketplace high deductible health plans.

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If you are going with any type of private commercial insurance, you will want to compare the premiums, co-pays, deductibles, co-insurance, and out-of-pocket maximums for the plans you’re considering. This will help you understand your potential healthcare costs for the year.

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What are the plan’s network of providers? Are your preferred doctors, clinics, and hospitals included? Is the plan an HMO, which has a more limited network of providers, or a PPO, which will typically have a more extensive, or even nationwide, panel of providers? You’ll also want to know if the plan offers out-of-network benefits. If it does, remember that deductibles and out-of-pocket costs are usually higher for out-of-network compared to in-network care. If a plan does not offer out of network benefits, then, except in emergency situations, it will not pay anything if you use out-of-network providers.  

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If you are purchasing health insurance on the Marketplace, you will want to find out if you qualify for subsidies or cost-sharing reductions. Subsidies and cost-sharing reductions can reduce your costs associated with the plan.

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There are specific times when you can sign up for health insurance through the Marketplace or your employer. Open Enrollment is the annual period when you can get, renew, change, or cancel your health care coverage. Missing this period means you might not have health coverage for a whole year, until the next open enrollment. For employer-provided coverage, the timing of open enrollment is determined by the employer and varies from company to company. Open enrollment for the Marketplace, known in Kentucky as kynect, is from November 1st to January 15th. If you sign up BEFORE December 15th, your coverage will begin on January 1st. If you sign up AFTER December 15th, your coverage will start on February 1st. After January 15th, you can only enroll or change plans if you qualify for a Special Enrollment Period.

The Special Enrollment Period is a time outside the regular open enrollment when you can sign up if you’ve had certain life events, like losing your health care coverage, moving, getting married, having a baby, adopting a child, or if your income drops below a certain amount.

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Qualified individuals and families can enroll in Medicaid or the Children’s Health Insurance Program, known as KCHIP in Kentucky, at any time.

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So, when choosing your health care coverage, determine what options you have available, consider the current or potential health care needs of you and your family, learn the details of each plan, and remember the key dates for enrollment. That way, you can find the best choice for you and your family.