Dec. 17, 2014
Knowing what’s important
when choosing a health plan, how to use benefits, and where to turn for help
can be challenging for most of us when purchasing health coverage. That’s why
the Texas Medical Association started the “Hey, Doc” educational campaign in
2013. We want to help Texas’ patients make the best choice possible when
purchasing their health insurance through the new health insurance marketplace.
This week we’re discussing the different kinds of health insurance plans
available and costs.
What will it cost me to buy
Your insurance costs depend
on a lot of things like where you live, your age, how many people are in your
family, the services you need, and whether you smoke. And your income
determines whether the federal government will help you pay for your insurance.
What you pay also depends on
which category of insurance you choose in the marketplace: bronze, silver, gold, or
platinum. In bronze and silver plans, you might pay a lower monthly charge,
called a “premium,” but you might have to pay a higher cost later when you use
the insurance. The opposite happens when you buy gold and platinum plans; they
tend to have higher premiums and lower out-of-pocket costs.
Here’s an idea of what those
costs might look like, on average:
- In a bronze
plan, insurers pay for 60 percent of the charge for medical services;
patients, 40 percent.
- In a silver
plan, insurers pay for 70 percent; patients, 30 percent.
- In a gold
plan, insurers pay for 80 percent; patients, 20 percent.
- In a platinum
plan, insurers pay for 90 percent; patients, 10 percent.
You won’t know your costs
for sure until you fill out a marketplace application. But until then, you can
get a rough idea using this calculator tool created
by the Kaiser Family Foundation.
And remember, regardless of
whether a plan is bronze, silver, gold, or platinum, don’t forget to check out
the other details besides costs, like the kind of insurance and the doctor and
hospital networks. Those things are important to keep in mind when comparing
your options and choosing a plan that works for you and your family.
What different kinds of
insurance can I buy?
There are different kinds of
insurance plans you can buy depending on how much you want to spend, the medical services you
need for you and your family, and how many doctors and hospitals you want to
choose from. Some plans, for example, only let you use the doctors that are in
their networks; otherwise, you pay more.
Others might require you to
get a referral from your regular doctor before you get other specialized
treatments. You can read up on Healthcare.gov and BeCoveredTexas.org about the different kinds
of insurance plans out there.
The marketplace also puts
these different kinds of insurance plans into four categories: bronze, silver,
gold, and platinum. The categories are based on the amount of coverage the
insurance company provides for your health care, and your portion of the costs.
But again, any plan in any of those categories still has to offer essential
benefits. The difference is how you and your insurance company share the costs
of that care.
There is a fifth option,
too, called “catastrophic insurance.” But it’s only for certain people, and it
doesn’t cover everything.
When does my coverage start?
During open enrollment for
2015, if you enroll:
- Between the
first and 15th day of the month, your coverage starts the first day of the
next month. So if you enroll on Jan. 5, 2015, your coverage starts on Feb.
1, 2015. And remember Dec. 15, 2014, is the last day to sign up for your
coverage to take effect on Jan. 1, 2015.
- Between the
16th and the last day of the month, your coverage starts the first day of
the second following month. So if you enroll between now and Dec. 31,
you coverage will start Feb. 1.
- Between Feb.
1, 2015, and the deadline of Feb. 15, 2015, your 2015 coverage begins
March 1, 2015.
You can find each week’s
“Hey, Doc” Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient blog at MeAndMyDoctor.com. And TMA produced “Hey, Doc” videos to help people understand
how to navigate the marketplace.
Below is TMA’s “Hey, Doc”
content schedule through January 2015.
Dec. 30: What is
catastrophic insurance? What is covered by this insurance?
Jan. 7: How Do I Pick a
Plan? How Many Plans Can I Pick? Can I Keep the Plan I Have Now?
Jan. 14: Who will take care
of me? What are the networks? How do I pick a doctor? Where can I find this
Jan. 21: Can I keep my
doctor or hospital when I sign up? How do I find out if my doctor is on my
insurance plan’s list? What should I do if I thought my doctor was included but
Jan. 28: Why is it important
that I pay my insurance premium on time? How do I know what kind of coverage I
have and if I can use my insurance?
TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.