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How to Choose a Health Insurance Plan

First, if you have health insurance, know its source, is it your employer, do you get your plan directly from an insurance provider, are you on Medicaid? Now figure out which option is right for you and if you and/or a family member qualify for any special assistance. If you are currently uninsured, the choice is easier; show for a plan on the Marketplace (see below).

To determine whether your current plan, employer sponsored plan, individual insurance, or other, is better than a Marketplace plans, you will need to look at your current plan, its benefits and out-of-pocket costs (premiums, deductible, copays, etc.). Compare it to plans available on the Marketplace. Compare plans based on what’s important to you. Choose the combination of price and coverage that fits your needs and budget. When making the comparison, some things to consider are whether you can keep your doctor on a Marketplace plan, if and how your medications are covered, and weigh monthly premiums verse deductible costs carefully.

Here is the catch. Let’s say your employer has more than 50 or more full-time equivalent (FTE) employees and offers “affordable” health insurance. “Affordable” health insurance is health insurance where the out-of-pocket premium for employee (single) coverage does not exceed 9.5% of family income or the plan pays 60% or more of the cost of covered services. Let’s say also that you don’t accept your employer’s health insurance plan, then you DO NOT qualify for premium tax credits. Otherwise, if this same employer doesn’t offer affordable health insurance and you choose not to accept it and go to the Marketplace for a plan, you may qualify for premium tax credits. It is important to weigh the coverage that the employer-sponsored health insurance provides against that available on in the Marketplace or Medicaid before declining coverage. So do the math. If it works out that your employer’s health insurance offering is not affordable then check out what you can get on the Marketplace.

 Some Facts:

  • Individuals earning between 100% and 400% of the federal poverty level (FPL) (in 2014 $23,550 and $94,200, respectively, for a family of four) will have access to premium tax credits (based on income and the number of insured individuals in your family) in order to make purchasing insurance in the Marketplace more affordable.
  • Individuals earning between 100% and 250% FPL will have access to cost-sharing subsidies that will bring down their out-of-pocket costs for deductibles, copayments, and coinsurance.
HELPFUL LINKS
Federal Poverty Guidelines Federal Poverty Guidelines – The poverty guidelines are a version of the federal poverty measure. They are issued each year in the Federal Register by the Department of Health and Human Services (HHS). View now >>>
Essential Health Benefits HFA Issue Brief Essential Health Benefits: HFA Issue Brief View now >>>
Essential Health Benefits - For information on each state EHB package Essential Health Benefits – For information on each state's EHB package. View now >>>
Out of Pocket Maximums Out of Pocket Maximums. The Affordable Care Act (ACA) sets maximum limits on how much a person can be required to pay out-of-pocket annually for his or her health care: HFA Issue Brief. View now >>>
Essential Health Benefits HFA Issue Brief Marketplace plans are required to meet certain requirements and will be determined to be a qualified health plan (QHP). Each QHP must provide a sufficient number of Essential Community Providers. View now >>>
Non-Exhaustive List of Essential Community Providers Non-Exhaustive List of Essential Community Providers View now >>>
Personal Insurance Toolkit Extensive toolkit developed by the National Hemophilia Foundation (NHF) and APLUS Coalition which HFA is a part of. View now >>>

Health Insurance Options

Which health insurance option is right for you? We have developed a list of the most common health insurance options available in the US. Please use the navigation to your Left or Right to explore them in detal.  A brief description is included with each. Click on the one that best fits your current situation or need.

Disclaimer. This website is a resource only and only should be used for information purposes. Please work with your health care providers, insurance councilors, etc., to determine the best solution for you.Veteran’s Health

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