Today marks the first day that you can enroll in health insurance through HealthCare.gov, the US government’s health insurance exchange. Open enrollment in 2018, for insurance that is effective January 1, 2019, is from November 1 through December 15. If you don’t have health insurance available to you through your employer, or any other source, then you want to make sure that you enroll in a marketplace plan before December 15 so that you have coverage for 2019. If you fail to enroll in a plan by December 15, and you don’t have a qualifying event in 2019 that makes you eligible for a Special Enrollment Period, then you’ll be without health insurance for the whole year or will have to resort to an option such as short-term health insurance, which is less than ideal.
Navigating the health insurance marketplace is very confusing, as I wrote about in September when I turned 26 and had to find a marketplace policy for myself. There are many things to consider such as costs, the type of plan offered, and if your preferred physicians are in the plan’s network.
Different Kinds of Plans
There are several different types of health insurance plans that provide different benefits of which you should be aware. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point-of-Service Plans (POS), and High-Deductible Health Plans (HDHPs).
All of these names seem pretty complicated and don’t really appear to mean much on the surface without diving into them. Out of the 22 plans available through HealthCare.gov in Indiana, the only two types available are HMOs and EPOs, so we’ll focus mainly on these two types of plans. Of those plans, two are HSA-eligible – one is an EPO and one is an HMO.
Here are some important things to know about each type of plan available in Indiana:
Health Maintenance Organizations (HMOs)
- Typically, you must choose a primary care physician and first consult with them before being able to see a specialist.
- Without a referral to a specialist from your primary care physician, you’ll have to pay all costs out-of-pocket.
- HMOs limit you to receiving care from physicians that are contracted with them – this is commonly referred to as the “network”.
- If you receive care (other than emergency care) from an out-of-network physician, then you’ll have to pay out of pocket for those services.
- HMOs can provide cheaper premiums than some other types of health insurance (such as PPOs) since they direct patients towards in-network physicians for an agreed upon amount.
Exclusive Provider Organization (EPO)
- Similar to HMO but may provide a different network.
- May not require that you have a primary care physician.
- Doesn’t require referrals from your primary care physician to see a specialist.
- EPOs limit you to receiving care from physicians that are within the plan’s network (except for emergency services). Otherwise, they won’t pay for the care.
- May provide a larger service area than an HMO.
HSA-Eligible High Deductible Health Plans
- A HDHP is a health insurance plan with a high deductible. Duh. The deductible is the amount that you have to pay before insurance kicks in.
- In 2019, the minimum deductible that a plan can have for self-only coverage to be considered an HDHP is $1,350 and double that at $2,700 for family plans.
- The maximum out-of-pocket expenses for HDHPs in 2019 is $6,750 for individuals and $13,500 for families.
- There are two HDHPs on the marketplace in Indiana – one is an HMO and one is an EPO.
- These plans are the only plans on the market in Indiana that are eligible to be paired with a Health Savings Account (HSA). Even those other plans that have deductibles high enough to be considered “high deductible” plans are not HSA-eligible.
- The 2019 HSA contribution limit for individuals is $3,500 for self-only coverage and $7,000 for those with family coverage.
Choosing between the HMO and EPO really comes down to which network works for you and if you want to be able to see a specialist without a referral from your primary care physician. You can visit each insurance company’s website to review their networks and see if your physicians are in them.
Don’t Go Without It
Don’t wait until December 15 to apply for health insurance coverage for 2019. Login (or create) an account and get a lay of the land. Take some time to figure out what plan is the best for your situation before applying to make sure that you’re making the best decision for you.
Some may think that they’ll just forgo the cost of health insurance since they could save so much and use that money for other things. That’s not a very good idea.
Life is unpredictable, and tragedy could strike at any moment. It’s not what we want to think about, but we must consider that something like a serious car accident is a potential for those of us who drive or take a ride sharing service to work every day. Even something as small as slipping and falling, or anything else that could lead to an emergency room visit, could result in extremely costly medical bills that could be devastating without insurance.
Just as the old saying goes, insurance isn’t something that we like paying for but it’s something that we’re glad is in place once the time comes that we must use it. Yes, health insurance is expensive, but paying for an accident without health insurance is much more expensive.
