What Is The Difference Between Washington State’s Public Option And President Joe Biden’s Proposed Public Option
Washington was the first state in the nation to implement and sell state-procured public option health plans. These plans are similar in many respects to those being proposed at the federal level by President Joe Biden.
Insurance Plan Care Types
After youve chosen a plan level, youll usually have a choice of how your healthcare is managed. Thats where HMO, PPO, POS, EPO plans come in.
HMO plans only pay for services from healthcare providers in the plans network of contracted providers, also known as in-network providers . And care is coordinated by a PCP, or primary care provider, who needs to refer you to in-network specialists or else the specialist wont be covered.
HMOs might feel restrictive, but there is an upside. Because an HMO insurer negotiates prices with a network of providers and can more or less predict costs for services, an HMO typically has lower premiums and deductibles than other plan care types.
In a PPO plan, the insurer will cover both in-network and out-of-network providers but at different rates: In-network providers will be cheaper than out-of-network providers. And generally, you can choose to see a specialist in the plans network on your own and wont need a referral.
However, for the flexibility that PPOs offer, youll likely have to pay a higher monthly premium compared to HMOs. And restrictions on certain services and medications may still apply that require prior authorizations before you can access to them.
So, which type of plan is the best? Hopefully, this guide has shown you that it really boils down to your healthcare needs, budget and preferences.
Seek Professional Advice To Choose A Plan
Selecting the right health care plan for all but the most basic coverage requires a thorough analysis of your unique circumstances. Dont go it alone.
A lot of times people will enroll without help and find out when its too late that they signed up for the wrong plan, says Jason Alford, VP of sales and business development at Health First Health Plans.
Theres no cost to you to use an independent insurance agent and they can help you identify a plan that will suit you and your family needs more efficiently than you might on your own. Insurance agents can review both plans on the health insurance exchange and plans with private insurers and your premiums will be the same cost whether you make use of an agent or muddle through the details yourself.
If you do use a broker, make sure theyre licensed and have a contract to sell marketplace health plans. Otherwise, they may not be able to provide the widest array of options for your situation and budget. Most importantly, if you qualify for savings and/or subsidies like tax credits from a marketplace health plan, make sure your broker knows this so they will review only relevant options. You can find a certified marketplace broker on the HealthCare.gov Find Assistance page.
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Here Are Five Things To Keep In Mind When You Shop At The Marketplace:
All Marketplace health plans cover the 10 Essential Health Benefits defined by the ACA law
The way you and your health insurance carrier split the costs of health care varies by plan level. But all Marketplace plans give you the same essential health benefits. For example, annual check-ups, routine mammograms, and diabetes screenings are 100% covered when you go in-network,* no matter which plan you choose. Every plan gives you access to other vital care, too. If you have to stay overnight in the hospital, go to an emergency room or clinic, get care for your kids, or get therapy and other treatments to get better, you’ll be covered.
Higher-priced plans pay a higher portion of your eligible medical bills
You’ll pay the highest monthly premium for a plan where the carrier pays the highest portion of your health care bills. Lets say you pay a higher monthly premium for your plan. In return, your plan pays a higher share of your eligible health care costs.
You can count on copays
Most plans have copays. The actual copay amount will vary based on the plan and the service.
Plans in the same metal level could have different deductibles and coinsurance
Deductibles and coinsurance can vary among plans in the same metal level. For example, two Gold plans will have the same annual out-of-pocket maximum, but different deductible and coinsurance amounts. So its best to read your plan documents closely. This way, youll know what you need to pay when you get care.
If You Have Access To Cobra It Might Be Your Best Option
If youre out of work, but had health care benefits through your previous employer, find out if youre eligible for continuing coverage benefits. This option is commonly called COBRA, for the Consolidated Omnibus Budget Reconciliation Act, which established the right for employees to keep their coverage for a limited period of time after their employment ends.
However, COBRA is a costly option while you get to keep your health plan, youre usually responsible for paying 100% of the premium, plus a 2% administration charge. Depending on your plan, this could cost you thousands of dollars until you find new employment.
As part of ARPA, employers are now required to cover 100% of premiums for eligible former employees who elect to have COBRA coverage between April 1 and Sept 30, 2021.
Theres also another cost-saving benefit to choosing your former employers COBRA plan to consider, in addition to the American Rescue Plan subsidy.
If you had a job and you lost it in June, you dont start a new deductible, you dont start new copays, all those things that can add up, Smedsrud says.
Typically, an employer must have had 20 or more employees to offer the benefit to workers who were let go. An employee who was dismissed for gross misconduct or who left their job voluntarily is typically not eligible for COBRA.
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Choosing Between Gold And Other Metal Level Plans
The type of health plan you choose is entirely dependent on your individual budget and needs. If you qualify for subsidies, and your budget allows, a gold plan could be great for you and your family. However, if youre on a tight budget, bronze plans might better suit your needs. In fact, if you qualify for subsidies and are within a certain income level, you could qualify for a zero premium bronze plan.6
Not sure if a gold plan will work best for you and your family? Luckily, thats exactly why were here. A licensed insurance agent can help you determine your subsidy eligibility, find coverage that matches your needs and budget, and even help you enroll before the Open Enrollment Deadline. All you have to do is give us a call at .
Difference #: Silver Requires Much More Storage Space
All those affordability advantages we just outlined come with a catch: it takes a LOT more space to store silver than gold.
At current prices, the same dollar investment will get you roughly 80 more ounces of silver than gold. On top of that, most silver is a lot less dense than goldpure silver is 84% larger in volume than pure gold. This means silver takes up as much as 128 times more space than gold for the same dollar value!
Here are some practical examples of that difference. At current prices
- You can hold $50,000 worth of gold in one handbut it would take about 10 large shoe boxes to hold the same dollar amount of silver.
- $50,000 worth of gold weighs about 2.6 poundsbut the same value of silver weighs about 189 pounds!
- You can store roughly $170,000 of gold in a small safe deposit box, but that same space will only hold about $2,300 of silver.
Its relatively easy to hide some gold coins in a sock drawer or cookie jar, but those same hiding places are impractical for the same investment in silver. Whether you buy coins or bars, youll need a lot more space to store silver than gold.
And because it requires more space, the fees for professional storage are higher with most depositories.
This difference applies to transporting physical silver as well: it may be more difficult, expensive, and cumbersome.
- Investor Implication: Gold takes up much less storage space than silver, is cheaper to store, is lighter and less cumbersome to transport, and doesnt tarnish.
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Your Guide To Choosing A Metal Tier
Most of us would rather endure intensive physical pain than have to choose a healthcare plan . Fortunately, Strides mission is to make this process far less painful.
There is no one size fits all when it comes to buying coverage – everyone is unique in their healthcare needs. To simplify the process, health plans are broken down into categories called Metal Tiers plan options that are similar in their costs and coverage. They are named in order of the precious metals: Bronze, Silver, Gold, and Platinum.
The Bronze plans have the least expensive monthly payments but offer the lowest amount of coverage, whereas Platinum plans have the most expensive monthly payments but offer the greatest amount of coverage.
Want to compare metal tier plans near you? Enter your zip code below to get started.
I like to compare health insurance shopping to buying a car. A Bronze plan is like buying a used car with a bunch of mileage – this car is going to get you around town and cover your basic needs. However, its not the best for that big cross country road trip, and it will cost you a lot when you need to repair it.
Financial Risk Assessment
If youre still unsure which plan is right, heres a quick way to financially assess your risk between two plans. Say youre deciding between a Bronze plan and a Silver plan .
Happy health plan hunting, and let us know if . Otherwise, enter your zip code below to get started comparing plans.
What Does Health Insurance Value Mean
The actuarial value tells you what percentage of covered healthcare expenses a plan is expected to pay for its membership as a whole. This doesnt mean that you, personally, will have exactly 80% of your healthcare costs paid by your gold plan . You might have more or less than 80% of your expenses paid depending on how you use your gold health plan. The value is an average spread across all of a plans members.
This is best illustrated with an example: Consider a person with a gold plan who only has one doctor visit during the year, and some lab work. Perhaps his copay is $35 per visit, and his insurance pays another $100 for the office visit. But the lab work is counted towards his deductible, so he has to pay the full bill, which ends up being $145 after the network negotiated discount. When it’s all said and done, he’s paid $180, and his insurance has paid $100. So his insurance only paid about 36% of his costs .
But now consider the same person, with the same gold plan, developing cancer during the year. He has several office visits at $35 each, meets his $2,500 deductible soon after the diagnosis, and hits his $3,500 out-of-pocket maximum before he even starts chemo. After that, his insurance pays for everything, as long as he stays in-network. At the end of the year, his insurance has paid $230,000 and he’s paid $3,500. So his insurance has covered more than 98% of his costs.
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What Are Metal Levels In Marketplace Health Insurance
Before you shop the Marketplace, your first question may be which metal level of health coverage is right for you. All health insurance plans in the Marketplace are broken into four metal-level tiers: Platinum, Gold, Silver, and Bronze. These metal levels only reflect the differences in how costs for your healthcare are split between you and your insurance company.
Generally speaking, plans with higher premiums have lower annual deductibles. And plans with lower monthly premiums tend to come with high deductibles. Depending on your annual medical costs, different metal levels will offer different kinds of value to you.
The different metal tiers in no way reflect a difference in the level of care you receive.
Thanks to the Affordable Care Act, all Marketplace plans must cover the following 10 categories of Essential Health Benefits:
- Ambulatory patient services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Remember that no matter which plan type you select, all Marketplace plans are whats known as Qualified Health Plans. And these plans must offer a set of preventive care services with no copayments.
You can see health plans and prices by entering your zip code below, as well as see how much of a subsidy you might be eligible for.
A Little More To Think About
If your income qualifies you for any of the Silver Enhanced Plans which are the Silver 73, Silver 87, and Silver 94 then look carefully at the plan benefits. You will notice lower deductibles and copayments which, oftentimes compared with the other metal plans, prove to be the best deal out there. And who doesnt want to take advantage of a good deal?
If you are considering a PPO Silver plan it is extremely important tonote that when the doctor or other provider is not part of an insurance companys network, the members cost for services will be higher. For additional information, please contact the carrier or our insurance agency.
Based on your income and household size, you may qualify for Cost Sharing Reduction, which means you may be able to get improved benefits on the Enhanced Silver Plan you qualify for with no additional cost. You can get these improved benefits as long as you qualify for a Silver Plan. View the Silver Plans in your quotes to see which Enhanced Silver Plan you qualify for.
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Whats The Difference Between Bronze Silver And Gold Plans
Who is this for?
If youre shopping for your own health coverage, this will help you compare your options by explaining what makes each metal tier unique.
To make shopping for health insurance easier, plans you purchase for you and your family are divided into metal tiers: bronze, silver and gold. We all know gold costs more than silver, and silver costs more than bronze. But when it comes to health plans, metal tiers tell you more than just price.
Other Things To Consider When Choosing Or Reviewing Your Health Insurance
Once youâve decided on which cover is right for you, itâs worth considering the extra things your health insurer provides that can make a difference, from helping you with your health goals, to value on your extras insurance, or support when going to hospital.
For example, Medibank members with hospital cover can call our 24/7 Medibank Nurse phone service to discuss their health concerns at any time of the day or night. We’re also providing Medibank at Home programs that allow eligible members, with their doctorâs support, to receive rehabilitation care from the comfort of their own home, and trialing, chemo, dialysis and palliative care~.
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When Should You Should Consider Bronze Health Insurance
Bronze health insurance may be suitable for you if you want a lower cost option that covers a wide range of common services, including gastrointestinal endoscopy and cancer treatments . It may also be suitable for young families looking for cover that includes common procedures for kids, like tonsil or grommet procedures. Keep in mind that a 12 month waiting period applies for any pre-existing health conditions.
If youâre looking for a lower cost option but want a few more services included, Bronze Plus cover options may be right for you.
And while Bronze and Bronze Plus covers offer a broad set of services, itâs still a good idea to compare them with Gold and Silver covers to ensure there are no other services you might need, like pregnancy and birth, or heart and vascular services.
What Metal Tier Cost Sharing Means For You
The percentages in the table above are useful because they give you a quick way to compare health plans. Plans that require you to pay more of your own money probably arenât the best option for someone who knows they will need to regularly visits the doctor, but they may be perfect for someone who is healthy and doesnât expect to go to the doctor very much.
However, the cost-sharing percentages are not what you will actually pay for your health care. Theyâre based on the total average costs that an insurer will pay over the course of a year for covered services and benefits.
The actual costs that you pay will depend on which health care services you use during the year and the details of your individual plan. Letâs say you have a Bronze plan, you go a whole year without getting needing medical care, and you only see your doctor for an annual physical. You will pay for less than 60% of your care over that year. On the other hand, an illness that requires major medical care and surgery could leave you paying for more than 60%.
Learn more about the different types of health insurance.
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