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Whether you’re purchasing your health insurance from a marketplace or a broker, there are various plans to consider in your healthcare pursuits. Each plan yields unique benefits while featuring its fair share of shortcomings. Often, those in the insurance sector categorize these plans by the number of benefits offered. The primary difference between different health insurance plans is the money paid periodically, with the more expensive plans lending to more comprehensive coverage. 

 

Choosing the wrong insurance plan for your family can be a costly mistake in the long run. Fortunately, you can follow this step-by-guide to locate the right coverage. 

healthcare market place

Select your healthcare marketplace

When shopping for a health insurance plan, you’ll stumble upon three different types of marketplacesall of which fall under private or public classifications. For your reference, there are state, federal, and private health plan marketplaces available to prospective beneficiaries. A prime example of a private health insurance provider is AHiX Marketplace

Private 

By definition, private health marketplaces allow beneficiaries the freedom to tailor their plans to their individual needs while meeting the designated requirements. When choosing this plan, it’s vital to confirm that you qualify for government subsidies, which require an application. 

 

The main advantage of opting for a private healthcare marketplace is the wide variety of plans available. Unlike other options, it’s easy for a prospective beneficiary to acquire a policy that doesn’t stretch your budget while still ensuring extensive coverage. 

State

State-based marketplaces are marketplaces where the government is the regulatory body for its health plans. The state runs every aspect of the market, from verifying eligibility to overseeing the enrollment process. In most cases, government websites are the platform of choice. 

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Other responsibilities assumed by the state include consumer service, marketing, and outreach. Some examples of states that uphold a state-based marketplace include California, New York, Colorado, Idaho, Vermont, Minnesota, Rhode Island, Maryland, Washington, and Connecticut.

Federal 

Federally Facilitated Marketplaces (FFM) are the insurance marketplaces managed by the United States Department of Health and Human Services (HHS). The Federal Government runs a marketplace where individuals and employers can apply for QHP (Qualified Health Plans). 

 

These plans aim to make healthcare affordable, allowing qualified persons to receive an Advance Premium Tax Credit (APTC), which subsidizes the premiums. Eligible persons also have the option of using cost-sharing reductions, which lowers their out-of-pocket costs. The Federal Government carries out annual training and accreditation for insurance brokers and agents who wish to assist consumers in the federal marketplace.

Assess the different types of plans

There are two main types of insurance plans: qualified and non-qualified plans.

A qualified health plan is one that’s certified by a health insurance marketplace. It also provides essential health benefits and adheres to various limits on cost-sharing such as:

  • Deductibles
  • Co-payments
  • Out-of-pocket maximum amounts

In addition to this, a qualified plan needs to meet the relevant minimum coverage standards mandated by the Affordable Care Act’s provisions. 

 

Non-qualified insurance plans, on the other hand, are essentially retirement savings plans. They don’t adhere to the Employee Retirement Income Security Act, hence their name “non-qualified plans.” In most cases, these plans are popular amongst top-earning executives, given that they provide higher retirement savings options.

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Deductibles, coinsurance, and co-payments

When choosing a health insurance marketplace, one of the critical issues to consider is the various out-of-pocket costs. Below are several out-of-pocket costs beneficiaries should assess before committing to a health insurance feplan. 

Deductibles

Deductibles are the minimum amount of money you must pay annually before the insurance policy can cover various hospital-based costs. These costs act as a cushion for the insurer in the case of a catastrophe or when costs incur all at once.

Coinsurance

Coinsurance is an amount that the insured is expected to pay for a claim after satisfying the deductible requirement. The most common deductible plans is an 80/20 split, where the insured caters for 20% of the costs, and the insurer covers the remaining 80%.

Co-payments 

Co-payments refer to a percentage of a claim that the insured incurs. In several insurance policies, co-payments are included as a mandatory clause, while in others, it’s an option that allows for lower premium payments.

Final word

When choosing insurance coverage for you and your loved ones, it’s crucial to opt for the insurance plan with the higher monthly premiums. Note that your insurer will cover a more generous portion of your medical costs after paying these high monthly premiums. 

 

Shopping for health insurance coverage for you and your family should be a priority due to its numerous advantages. For one, comprehensive health insurance coverage can insulate your family from the financial burdens often associated with chronic illness diagnoses or tragic accidents. Utilizing an insurance marketplace also grants you the opportunity to get free preventative care, such as vaccinations for you and your family.