Open enrollment for health insurance is from November 1st through December 15th.
Personal insurance protects you and your loved ones against the risks of death, injury, illness, and other incidental costs. No matter how safe or cautious you think you are, life comes at you fast. If you don’t protect yourself, you could find yourself in bankruptcy, or working extra jobs to pay off unexpected debt.
Choosing what protection is best for you can be complicated. We’ve listed some of the main types of personal insurance we offer below along with explanations of what they are and how they protect you. That said, we’d really love it if you contacted us so we can speak over the phone or in person so we can discuss all options available to you.
- Special Enrollment Period
- A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.
- Premium Tax Credits
- The premium tax credit is a refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Health Insurance Marketplace, also known as the Exchange. … If you owe no tax, you can get the full amount of the credit as a refund.
- Cost Sharing Reduction
- Cost Sharing Reduction (CSR) A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
A deductible is the amount you pay for health care services before your health insurance begins to pay.
How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.
A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20. If you’ve paid your deductible: You pay $20, usually at the time of the visit. If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.
Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists.Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.
An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year. If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. Some health insurance plans call this an out-of-pocket limit.
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible.
How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan pays 70 percent. The 30 percent you pay is your coinsurance.
- Out-of-Pocket Maximum
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn’t include your monthly premiums. It also doesn’t include anything you spend for services your plan doesn’t cover.
Let’s say you need surgery with allowable costs of $20,000, and the following figures apply to your health insurance plan.
- Deductible: $1,300
- Co-Insurance: 20%
- Out-of-Pocket Maximum: $4,400
You pay the first $1,300 of covered medical expenses (your deductible).
Your 20% coinsurance on the rest of the costs ($18,700) comes to $3,740.
So your total costs would be $5,040. That’s $1,300 (your deductible) plus $3,740 (coinsurance).
But your out-of-pocket maximum is $4,400. Your insurance company pays all covered costs above $4,400 — for this surgery and any covered care you get for the rest of the plan year.
Generally, plans with lower monthly premiums have higher out-of-pocket limits. Plans with higher premiums usually have lower out-of-pocket maximums.