Tips for Those Shopping on the Health Insurance Marketplace

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(Photo : Jordan Madrud via Unsplash)

Health insurance coverage has become a great necessity for most people. According to the US Department of Health and Human Services, more than 30 million Americans possess health coverage under the Affordable Care Act. This has been accompanied by a drastic reduction in uninsurance rates across the country.

While this is excellent news, shopping for health insurance is far from fun and games. (Not that home insurance is a walk in the park, either.) You need all the insight you can get on the Health Insurance Marketplace, especially when not working directly with an insurance company or agent.

Here are a few tips to get you started.

1. You can change your health coverage once a year

Open enrollment for health insurance allows you to change your health coverage annually. You get a chance to reexamine your previous choices and determine whether you have taken full advantage of all the benefits available to you.

If your plan changes, it might be time to switch providers. Whether looking for a new dentist in Frankfort IL, or a reliable doctor in Scottsdale AZ, maximizing your insurance benefits by finding a new provider is essential. Otherwise, you may find yourself scrambling to schedule an appointment when it's too late.

2. Know your enrollment deadline

If you are self-employed or not covered through an employer, you can buy your policy on the government's Health Insurance Marketplace. Open enrollment for this federal marketplace runs from November to December 15th.

In case you miss your window for open enrollment, you can end up with no coverage at all or be denied the chance to make changes in your current coverage. You must then wait for the next enrollment.

3. A little window shopping doesn't hurt

When you head to the 'healthcare.gov' website, you will be prompted to create an account or preview plans and prices. Creating an account demands a lot of information from you, such as your household income coupled with some more eligibility requirements.

However, choosing to preview plans and prices is faster in finding what you want without initial commitment. Once you have had time to review, compare, and contrast the different coverage offerings, and identify the one that resonates with your needs, decide whether you are ready to enroll and create an account.

4. Understand what the plans cover

All insurance plans on the Health Insurance Marketplace cover essential health benefits, preventive services, and preexisting conditions.

Some essential health insurance plans cover prescription drug coverage, mental health services, doctor's services, dental coverage, laboratory services, pregnancy, and childbirth.

Preexisting conditions like cancer, diabetes, and asthma are also covered. Preventive services covered mostly include screening tests and shots.

5. Know your coverage options

Based on your income, you may qualify for a health insurance plan with tax credits or Medicaid and the Children's Health Insurance Program (CHIP). If you fall in the moderate or low-income category, both these options will offer either free or low-cost health coverage to you or your loved ones.

What's more, you are allowed to apply for Medicaid and CHIP throughout the year. They do not have open enrollment periods. To see if you qualify for these benefits based on your income, launch your search here.

6. Be keen on the doctor and hospital networks

As you shift to a new health insurance plan, ensure you know the doctors and hospitals that work with the insurance company. Health insurance plans tend to restrict your coverage to a network of preferred doctors and hospitals. It is not uncommon for patients to pay more if they use out-of-network care.

7. Your coverage doesn't start immediately

Enrolling in a medical or dental plan doesn't set the ball rolling instantly or the day after. You must apply before the 15th of the stipulated month for your coverage to take effect on the first day of the following month. If you apply after the 15th, expect some delays in coverage.

8. Understand the true cost of your coverage

You don't just pay your monthly health insurance premium and sit back. Seek to find out if there are any other costs involved. Most of the plans that you enroll for may require some degree of cost-sharing that you must cater to once in possession of your medical care.

The cost-sharing may include deductibles, copayments, coinsurance, or similar charges. For Medicaid and CHIP cost-sharing also includes premiums.

9. Evaluate your health insurance plans like a pro

Don't settle for a health insurance plan based on price alone. A cheaper plan may come with higher deductibles and more restrictions. Focus instead on your carrier and how big or small the carrier network is.