This is how much you’ll have to pay for out-of-pocket for different medical services before your policy starts paying for you. To simplify, if your plan has a $500 deductible, this means that you won’t have to pay for anything until you’ve spent that amount. Look into the limits of your deductibles as some do not apply to services such as vaccines and wellness visits!
This is your share when you claim any medical service. You only start paying for your insurance policy’s co-insurance after you have met your deductible. For example, you might end up paying around 20% of the cost of the service, whilst your provider pays for 80%. Note that the lower your monthly premiums are, the higher the co-insurance amount will be—so weigh the pros and cons properly.
This pertains to the payments you make in order to maintain your policy. This can be paid monthly, quarterly, or yearly.
When it comes to certain services, your provider might require a co-pay, which is typically a flat fee that you give to the individual or company providing you with health services. For example, you might be asked to pay, out-of-pocket, a $20-flat fee for every doctor’s visit. Note that these co-pays are usually higher if you’re going to the ER or visiting a specialist.
There are policies that will require you to pay both co-insurance and co-pay. You might find that they are also necessary if you’re purchasing prescription meds. If you have a chronic health condition that requires regular doctor’s visits and you’re on medication, it would be a good investment to find plans with lower co-pays that suit your needs.
5.WHEN CAN YOU SIGN-UP FOR A HEALTH PLAN?
Under ACA, you can purchase a healthy policy only during open enrollment so it pays to be mindful of when those dates are for every year. Now, there are also special exceptions that would allow you to purchase at other times. Exceptions include: if you have a child, if you move to a new state, change jobs, get divorced, or get married.
6.MUST I PURCHASE MY POLICY FROM THE MARKET PLACE?
For U.S. residents who don’t have access through a plan via an employer or their parents, they can purchase a policy directly from the provider or through the government-run marketplace. However, do note that the ACA premium subsidies are only available for policies that were purchased from the marketplace. It is recommended that you take advantage of these if your income doesn’t go past the 400% of the federal poverty level. Needless to say, for people following tight money management, this should help lower overall costs for you.
TIP: It would be good to search within the marketplace and outside of it. Note that policies, whether they’re sold on or off, will offer the same minimum benefits. You might even score a great deal from an off-market provider! This is also useful advice if you don’t qualify for any government subsidies.
7.WHAT WILL HAPPEN WHEN I REACH 26 YEARS OF AGE?
Under ACA, you are covered by your parents’ insurance up until this age. Past it, you will have to apply for insurance on your own. Note that if your birthday falls outside of the open enrollment period, you will likely qualify for special enrollment. It would be wise to start looking around before you even turn 26; this ensures there wouldn’t be any gaps in coverage during your transition between the old insurance plan and the new one.
8.DOES MY STUDENT HEALTH INSURANCE QUALIFY UNDER ACA / OBAMACARE?
The simple answer is, MAYBE. For this, you would want to check with your health plan administrator. This should enable you to assess if your student plan meets the requirements stated in the ACA. Remember, in order to qualify, your current plan must cover preventive services, as well as essential services.
9.WHAT IF I HAVE COVERAGE THROUGH MY EMPLOYER AND MY PARENTS’ PLAN?
In cases such as this, one becomes your primary and the other is secondary. Your two providers will coordinate coverage. Basically, your workplace plan will be primary and your parents’ will be secondary. You are not allowed to have two different insurance plans that cover the same benefits.
Remember, your primary plan will pay your claims with deductibles subtracted from it, as well as co-insurance and co-pay. Your secondary will pay any of the unpaid balance you have left after you reach the deductible amount.
Are there benefits? Not really, since you will be paying two times the premium—one for each plan.
10.IS A CATASTROPHIC PLAN IMPORTANT?
This type of plan is meant to protect you from costly accidents or any serious illnesses—basically, worst-case scenarios. It only comes into play after you have paid for many of your medical care from your own pocket. You might be eligible for this insurance plan if you’re under 30.
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