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Signing up for health insurance can seem intimidating. If you haven’t picked a plan and enrolled in coverage before, it can confuse and overwhelm you. Below, we break down your options and list what steps you need to take to sign up for health insurance.
What Are Your Health Insurance Options?
When it comes to health insurance, you have four main options.
- Private insurance: If you’re self-employed or if your employer doesn’t offer health insurance, you can get covered through the health insurance marketplace.
- Employer-sponsored insurance: Employer-sponsored insurance — insurance you get as part of your job benefits — covers over half of the non-elderly population.1
- Government-offered insurance: If you have a disability, are low-income or are over the age of 65, you may qualify for government programs like Medicaid or Medicare.
- Short-term insurance: Shorter-term insurance or temporary insurance can fill a gap in coverage. It’s a good option for people who miss the open enrollment period for private insurance or are between jobs.2
What Do You Need to Know Before Choosing a Plan?
Whether you’re purchasing an insurance plan through Healthcare.gov or picking one from your employer’s benefits package, you need to know some key terms to make an informed choice.
Deductibles and premiums
Deductibles and premiums are two of the most significant factors that affect the cost of your insurance plan.
You pay a premium each month to have an insurance policy. You pay the same amount, even if you don’t visit a doctor or fill a prescription.3
By contrast, the deductible is how much you pay for healthcare before your insurance starts to pay for your care. For example, if you have a $2,000 deductible, you have to pay for the first $2,000 of covered services before your insurer will start to cover procedures.4
If you want a low deductible — meaning you want your health insurance plan to start paying for coverage sooner — expect to pay a higher premium. If you are reasonably healthy and want to keep costs down, a plan with a higher deductible and lower monthly premium may be better for you.
Copayments
Your copayment is a fixed amount you pay for covered health services after you’ve met your deductible. For example, let’s say you have a $500 deductible and a $20 copay for visits to the doctor.
If you haven’t met your deductible, you’re responsible for paying for the full cost of the office visit on your own. Once you reach your deductible — $500 — then you just pay $20 per office visit.
Your copay amount can vary for different services, such as prescriptions, lab tests, and specialist visits.5
Coinsurance
Your coinsurance is the percentage of covered healthcare costs that you have to pay for yourself after you’ve paid your deductible. For example, once you’ve reached your deductible, your coinsurance payment may be 20%. If you had a $1,000 treatment, you’d be responsible for $200 of the charges; your insurance would cover the remaining $800.6
Network types
A health insurance network is a group of healthcare providers that have contracted with a health insurance plan to provide services as a specified price. The different types of plans will have different levels of access to doctors and specialists. Common network types include:
- Health Maintenance Organization (HMO): With an HMO, you can typically only see doctors that are within the network– except in emergencies, when the plan will cover medically necessary care. To see a specialist, your primary care physician will need to provide you with a referral before you can make an appointment.7 HMOs tend to be one of the cheapest types of health insurance.
- Point of Service (POS): As with an HMO, you will need a primary physician and need referrals to see a specialist. However, a POS will cover out-of-network services, usually at a higher cost. The monthly premiums can be more than those of an HMO.
- Exclusive Provider Organization (EPO): An EPO is a managed care plan, where services are only covered if you visit providers within the network.7 The plan may or may not require referrals to see specialists. An EPO network is larger than that of an HMO. Likewise, the premiums will be more than an HMO but less than a PPO.8
- Preferred Provider Organization (PPO): With a PPO, you pay less if you go to a provider in the plan’s network but you can visit doctors outside the network if you wish, without a referral. Your costs will likely be more because of this flexibility. Referrals typically aren’t needed. PPOs are usually the most expensive option of the four network types.
What Are the Metal Tiers?
With most insurance plans, there are tiers of coverage. For example, Health Insurance Marketplace plans are divided into bronze, silver, gold, and platinum plans.
Bronze plans have the lowest monthly premiums but the highest deductibles. They’re good for relatively young and healthy people who rarely need medical attention but want insurance in case of emergencies. After you meet your deductible, insurers pay 60% of covered care.
Platinum plans are the opposite. They have the highest monthly premiums but the lowest deductibles. After you meet your deductible, your policy pays for 90% of covered care. They’re best for people with ongoing medical needs or chronic conditions.9
| Coinsurance By Tier | ||
| Insurer Pays | You Pay | |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
How Do You Enroll?
You can apply for insurance online, over the phone, through the mail, or in person.
To finish the enrollment process as quickly as possible, have the following information handy before you start the application.
- Personal information for all applicants: Make sure you have the names, addresses, birthdates, and Social Security numbers for all family members who will apply for health insurance
- Income: You’ll be asked for your family size and income, so have a W-2, recent pay stub, or tax return to help you.
- Healthcare provider and prescription information: If you have doctors you like or take medications, keep a list of both nearby. Most insurance plans allow you to check if healthcare providers and medications are covered before you apply.
- Payment information: Once your application is accepted, you’ll have to pay the first month’s premium. Be prepared to pay the premiums with a credit card, checking account, or debit card.
After you’ve submitted your application and paid the first premium, the insurance company will mail your insurance cards. If you need to see a doctor or fill a prescription before then, contact your insurance company. You may be able to download a temporary insurance card. You could also get your member and group identification numbers over the phone, which you can then give to your doctor or pharmacy for billing purposes.
If you need help, call the insurer’s customer service line. The customer support team can help you navigate through the process and answer your questions.
