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How to get the right health insurance coverage for you and your family

The Affordable Care Act now requires most Americans to have health insurance or else pay a tax penalty. It also makes government subsidies available to consumers earning less than 400% of the Federal Poverty Level. What it doesn’t do, however, is effectively reduce the cost of medical care and health insurance today.

Now that most Americans are required to have insurance, many of them will be looking for creative ways to keep their out-of-pocket costs in check. Here are some specific dos and don’ts to help you save money while maintaining the health coverage you and your family need.


Do comparison shop for health plans both on and off government exchanges

Did you know that you can meet your coverage requirements under the health reform law by purchasing coverage through a government exchange or through another source like a licensed agent or insurance company? Government-run insurance exchanges are primarily designed to match subsidy-eligible individuals with subsidy-eligible health plans. But not all plans are eligible for purchase with a subsidy, and some brand-name insurance companies don’t offer plans through government exchanges.

The best way to find the right plan for your needs and budget is to comparison shop from as many different insurance companies and plans as possible, especially if you’re not using a government subsidy to help pay for coverage. 

Do consider opening a Health Savings Account

Health Savings Accounts (HSAs) are tax-advantaged medical savings accounts that can only be used in conjunction with qualifying HSA-eligible health plans. These plans typically come with higher annual deductibles, but they may have lower monthly premiums.

Unless you’re a frequent user of medical care, consider enrolling in an HSA-eligible health insurance plan and opening a Health Savings Account. You can deposit pre-tax or tax-deductible money into the account and use those funds to pay for qualified medical expenses (including copayments and deductibles). Money not used in one year will roll over to the next. The contribution limit for HSAs in 2014 is $3,300 for individuals or $6,550 for families. 

Do use your coverage (especially your deductible) strategically

You have health insurance for a reason and it generally works to your benefit when you need medical care. However, there may be times when it makes more sense to pay for medical care out of pocket, as if you were uninsured. For example, assume you need a medical procedure right now. If your deductible is about to renew for the next year and you still have a long way to go before fulfilling that deductible, ask your doctor how much your visit would cost without insurance. Then ask if they can provide you with a discounted rate for cash payment.

Compare that to how much you would pay out-of-pocket if the claim were processed through your insurance company and applied toward your deductible. It may make more sense to pay cash in certain cases. 

Do consult an expert to help you navigate your options

Health care insurance options aren’t always cut and dry. Each plan will fit into your lifestyle in different ways. Some might fit reasonably well at first, but not perfectly, and then a factor you didn’t consider might throw a wrench into things. Now your once reasonably-fitting health plan is costing you a lot of money for coverage that doesn’t help you.

There are licensed health insurance agent who can evaluate your finances and lifestyle, and help you find health care that will fit your needs as best as possible—and maybe even help bring light to factors that might cause you trouble down the road. 


Do not wait until you’re actually sick to sign up for health insurance

The Affordable Care Act creates specific open enrollment periods outside of which it’s difficult to get insured. The first-ever open enrollment period closes after March 31, 2014, and the next open enrollment period (for plans starting January 1, 2015) doesn’t start until November 15, 2014.

Between April 1 and November 15, then, you may not be able to purchase coverage unless you experience a qualifying event like marriage, the birth of a child, or the loss of employer-based coverage. If you’re uninsured for more than three consecutive months in 2014, you may also face tax penalties of $95 per adult and $47.50 per child or 1% of your taxable income, whichever is greater.

Do not automatically sign up for a subsidy if you earn close to the limit

Government health insurance subsidies are designed to make coverage more affordable for American consumers earning less than 400% of the Federal Poverty Level (about $46,000 for a single person or $95,000 for a family of four). The amount of subsidy assistance you receive will depend on your income for the current year and on the cost of benchmark health plans in your area.

You should know, however, that if you earn a bit more than expected, you may lose your eligibility for subsidies and have to pay them back. If you’re worried about your eligibility, you can adjust your subsidies mid-year or opt to deduct them on your tax return at the end of the year rather than have them applied up-front. 

Do not think that health insurance isn’t worth it

Health insurance isn’t cheap, and when you add up the monthly premiums, copayments, and deductibles, it may sometimes feel like you’re not getting a lot for your money. But the fact is that without health insurance, a single serious illness or injury can send you into bankruptcy. Health insurance plans limit your financial liability for runaway medical bills. Even when your claims are processed towards your annual deductible, you’re still benefiting from reduced rates. Your health insurance company negotiates these reduced rates with doctors and hospitals on your behalf. Without coverage, you could easily be spending twice as much for the same medical care.

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Health insurance and the cost of medical care can be intimidating, but there are creative ways to save money within the system. To learn more about your health insurance options and what the health reform law means for you, work with a licensed online health insurance agent.

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Carrie McLeanDirector, Customer Service, Retention

Carrie is responsible for the implementation of eHealth's ongoing Customer Care Center training and support programs. She has nearly 15 years of experience managing and training customer support teams, at eHealth and Harley Davidson Motorcycles....

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