Today, health insurance is a must-have for all Americans, kids included. By law, parents who don’t have health insurance or doesn’t have one for their kids might face stiff penalties each year. (Image source: Acko)
In case, someone gets sick or hurt a family has to shoulder the expenses for medical care. Most likely, it will cost more than paying a health insurance coverage. And we’re just talking of one hospital visit – What if there are more?
To help the citizenry of Nevada, the federal and state government organized a health insurance marketplace, also known as the health care exchange. Getting coverage was made easy, but the procedure made it confusing.
This is what to do before securing a health insurance plan for your child.
Check before you apply
Before enrolling your child in a health insurance plan, figure out if you or your child can get coverage through other means. A person is covered if they have Medicare, a Nevada Medicaid, the state-run child health insurance plan (CHIP), or insurance through a parent or a spouse’s job. Your child might be covered or could be qualified for free or low-cost insurance via a public program.
If you or your child are uninsured, you can apply for CHIP or Nevada Medicaid or shop for a plan through the U.S. Government comprehensive health care website.
You can only buy insurance through the healthcare marketplace during the open enrolment period from mid-November up to February. If you were not able to enroll, you or your child can get insurance from a private insurer for that year.
Some states run the health care exchange themselves others is run by healthcare.gov. For more information, visit the state’s official marketplace website or through healthcare.gov or through the U.S. Government’s helpline at 1-800-3182596.
What to look for when choosing a policy?
Importantly, the words you need to remember and understand are premium and deductible. The premium is the monthly payment for the coverage. The deductible is the amount you pay annually for medical service before the health insurance plan apply. Health insurance plans with low premiums have high deductibles, plans with high premiums have low deductibles.
Here are the basic levels of coverage:
Protects a healthy person in case of a major injury or illness. It is offered to people under 30 and those who are exempted from other plans due to poverty. This type of insurance has low premiums and very high deductibles. Plans shoulder less than 60% of the health care costs.
This plan has low premiums and high deductibles but offers better coverage than catastrophic insurance paying for 60% of costs.
Silver and gold plans
Both plans have average-sized premiums and deductibles. The silver plan covers 70% of costs and the gold plan pay 80% of costs.
Have the highest level of coverage with high premiums and low deductibles. This plan covers over 90% of costs.
All plans offer free or discounted fee from a doctor’s service for routine checkups, vaccinations, and some preventive care. Specific benefits vary from plan to plan so you have to know what each plan offers. Make a decision on how well the plan meets you and your family’s needs.
Types of insurance plans
The most common types of insurance plans in the Marketplace are:
HMO: Health Maintenance Organization
This organization is composed of medical insurance providers that limit medical care to doctors under the contract of HMO. The fee is paid on a monthly or annual basis. Premiums are lower because the health providers have the advantage of having the patients led to them. These contracts have restrictions to members. Enrollees receive medical aid from an assigned doctor also called a primary care physician (PCP).
PPOs: Preferred Provider Organization
You pay less for the services of providers in the plan’s network. The assistance of doctors, hospitals, and providers outside of the network is allowed without a referral for an additional cost.
EPOs: Exclusive Provider Organization
A managed care plan that provides services only if doctors, specialists, hospitals are included in their network, except for emergency cases.
POS: Pont of Service Plan
A plan where you pay less for the services of doctors, hospitals, and other health care providers included in the network. A referral from a PCP is required for a visit to a specialist.
When comparing plans look for the summary of benefits that are provided by online marketplaces together with the cost. A provider’s index lists the doctors and hospitals in the plan’s network
Choosing the best health insurance plan for your kid
Check your marketplace and view the plans offered by the health insurance providers. Make a checklist and jot down information about costs, services, doctors, requirements, and other medical needs of your family.
Discard plans that exclude your doctor in their network. Remember that you have to shoulder the cost if you avail the services of your preferred doctor.
Decide if you need more insurance health coverage and pay higher premiums or lower premiums, less coverage with higher out-of-pocket expenses – Bronze, Silver, Gold, Platinum.
Determine the type of plan that will work for you and your kid’s needs – HMO, PPO, EPO, or POS.
Review your checklist and look at your budget. Choose a plan that fits the budget.
Make sure your choice will cover you and your kid’s basic care such as prescriptions and specialists.