Health Plans – How to Cover Medical Bills?

Today, the prices for medical insurance in the United States are unreasonably high. As a result, if the system is not changed, then the prices for insurance and medicine in general will only grow. One of Barack Obama’s campaign promises was to reform and make healthcare available to all Americans. The draft of this reform is called Obamacare. There were many obstacles on the way to the implementation of the reform. However, as Obama said, “It came here to stay,” the reform was launched and is currently being actively promoted among all residents, promising affordable prices for health insurance.

The main goal of the ongoing reform is to insure all uninsured who are unable to purchase insurance at affordable prices, starting January 1, 2014. Immediately after the launch of the official website, which turned out to be completely inoperable, criticizing comments were sent to Obama starting from ordinary people to the political elite. But the Obama team is working to improve the project and still invites everyone to search for available insurance on the site.

Who does the Obamacare program care about in the first place?

Obamacare cares about those who are unemployed, or who are employed but do not have access to employer-sponsored insurance, and the elderly – that is, all those who have limited access to low-cost insurance for various reasons.

Can we hope that this program will offer you interesting rates in the insurance market if you are employed and your employer offers insurance, albeit not with the best prices? More likely not than yes, because you have access to insurance, which, albeit in part, is sponsored by your employer. If, of course, your salary is not lower than the minimum.

The best way to check is to apply at the official website and wait for the results, which are not coming very quickly at the moment. You will be asked to provide all information about yourself, including your status and income. You will then be told if you are eligible for free Medicaid / Medicare, or if you are eligible for discounts on market plans and how much. Next, you will need to compare different insurance plans and choose the one that suits you best.

The insurance purchase period for the next year began on October 1, 2020 and will be open until March 31, 2021. If the insurance was purchased before December 15, 2020, it will be effective from January 1, 2021. If later, then the insurance begins to operate from the 1st day of the next month, provided that you purchased it before the 15th day of the current month. The policy is purchased for a year, and it will not be possible to refuse it during this year, and it is possible to make changes to the purchased plan only in certain cases.

How US health insurance works?

Some of the largest players in the Illinois insurance market today are Aetna, Humana, Coventry, Blue Cross Blue Shield, Cigna, and others. Each company has many insurance options, and you need to know to determine which one is best for you:

• premium – monthly insurance payments;
• deductible – the amount you must pay for medical services before your insurance begins to cover them;
• co-payment – a fixed amount of co-payment for a visit to a doctor, medical service or medicine;
• co-insurance – coverage of expenses by the insurance company and you as a percentage, starting after full payment of the deductible;
• out-of-pocket limit – the maximum amount spent from your pocket during the year, upon reaching which, the insurance begins to cover your expenses in 100%;
• annual limit – the annual limit for the coverage of your medical expenses by the insurance company.

The patient’s insurance plan looks like this:

• $ 200 – premiums;
• $ 1,000 – deductible;
• 20% – co-insurance;
• $ 3,000 – out-of-pocket limit;
• $ 2,000,000 – annual limit.

What you need to know when choosing insurance in the USA?

In general, many insurance plans can be divided into three main groups:

• Catastrophic and Bronze: lower monthly payments (premium), but high deductible and not profitable co-insurance percentage. This is a plan for those who want to save on monthly payments and hope not to get sick next year, although they understand that if they go to a doctor, they will have to spend significant amounts on treatment until deductible is reached. This plan is more likely to deal with unpredictable illnesses and will protect against catastrophic costs for serious illnesses. Importantly, a disastrous plan can only be acquired by people under the age of 29. “Bronze” plans do not have an age limit.
• Medium / Silver: This is probably the plan chosen by the majority of the population. Higher premiums are offered here, but deductible and out-of-pocket will be lower, and the percentage of co-insurance will be approximately 80% to 20%. When choosing this plan, people pay significant sums in the form of monthly premiums, but on the other hand, their pocket will not suffer much in case of frequent visits to doctors.
• High / Gold and Platinum: the highest premiums, the lowest deductible and out-of-pocket, co-insurance will be 80/20 and higher. This plan is beneficial for those who plan regular visits to doctors and treatment, and at the same time want to hedge against high costs for services, but are willing to contribute significant monthly sums.

As you can see, the prices can vary significantly, and the examples of prices shown were found according to the given parameters, as indicated above – for a resident of Illinois at the age of 27. From the examples it can be seen that the higher the monthly payments, the lower the deductible and out-of-pocket maximum, and vice versa. However, when choosing a plan, it is important to pay attention to all the details of the proposed coverage.

Often, each type of insurance covers 100% for preventive visits to a doctor once a year (including a gynecologist), for vaccinations, diagnostics associated with these preventive visits. And then, if there are more medical expenses, the patient pays the deductible, and the further algorithm is already clear to you.

At the same time, you should always remember that each insurance company offers the best rates when choosing doctors from its network (in-network), and if you go to out-of-network doctors, all payment conditions deteriorate sharply. And if the high / gold plan also offers to partially sponsor these costs, then medium / silver will offer you a completely uninteresting percentage of co-insurance, and the catastrophic plan will not cover such costs at all.

This is important to know when choosing insurance, it is worthwhile to study in advance how wide the network of doctors and medical institutions that are covered by this insurance company, and always be careful about choosing a clinic or doctor.