Welcome to HealthPlanRate.com!
Welcome to HealthPlanRate.com, the internet’s leading resource for finding affordable healthcare plan rates. Everyone’s healthcare needs vary, and we offer extensive information to help you understand which healthcare plan is right for you. Learn more about how to find the best healthcare plan for you and your family.
Health Insurance Marketplace Plans
The 2010 Affordable Care Act (ACA) is a healthcare reform law that has widened the availability of affordable health insurance. To increase individual access to affordable health insurance, the government launched HealthCare.gov, an online marketplace where people can search for, purchase, and enroll in health insurance. Individuals and families are given a variety of healthcare plans to choose from. The Marketplace offers comparable healthcare plans that are affordable and cover the essential health benefits required by the ACA. Regardless of your income, family size, state, and/or medical needs, the right plan is out there. Finding the right plan may initially seem complicated, but it’s important to explore all options. Comparing various health plan options can help you find what is most affordable and works best for you or your family. Even if you do qualify for a Marketplace plan, be sure to explore other options that may be more suitable to your personal needs and preferences.
Affordable healthcare plan options are available outside of the ACA Marketplace. Cost-sharing plans are offered by private, non-government companies. It’s important to research the services covered by specific cost-sharing plans, as many of them may not cover the essential benefits required by the ACA and reject those with pre-existing medical conditions.
Learn more about cost-sharing plans here.
While some health insurance companies offer a diverse network of health providers, some people may feel frustrated by the lack of control they have over their service choices. Indemnity health plans offer individuals flexibility and a high level of freedom when it comes to choosing doctors, healthcare professionals, hospitals, and service providers. This plan can be suitable for someone who wants control of their own healthcare choices that they would otherwise not have with a traditional health insurance plan. Indemnity plans do not designate primary care physicians to patients and do not require them to obtain referrals before visiting specialists.
Indemnity plans offer limited protections. Some plans may not cover preventative services or provide coverage for medical costs associated with pre-existing conditions. Indemnity plans do not provide coverage for all of the essential health benefits required under the ACA, and are therefore not legally considered health insurance.
Learn more about indemnity plans here.
What Is a Health Insurance Marketplace?
A Health Insurance Marketplace is a service that helps individuals and families search for, purchase, and enroll in affordable health care plans. The Marketplace can be found on HealthCare.gov, a federal website created under the provisions of the ACA. Its purpose is to expand access to affordable healthcare by providing a network of various health insurance plans.
The federal government developed the Marketplace to accompany the ACA’s mission to expand access to affordable healthcare. Individuals can navigate the website to compare plan options, apply for Medicaid or private health coverage, and request cost assistance for healthcare expenses. Aid is available through call centers, in-person services, and links to other healthcare shopping websites. While most states use HealthCare.gov to enroll in health insurance, residents of the following 13 states should use their state’s own website to enroll in a healthcare plan:
- District of Columbia
- New York
- Rhode Island
The Affordable Care Act (ACA), often referred to as “Obamacare,” is a healthcare reform law enacted during former President Barack Obama’s first term. Since its enactment in 2010, the ACA has implemented mandatory changes to our healthcare laws across all 50 states. Its primary goals are to increase access to affordable health insurance, curb rising healthcare costs, and expand the Medicaid program to cover individuals living under the federal poverty level. These provisions fall under the government’s objective goal to extend health insurance coverage to the 32 million Americans living uninsured.
Its provisions, which went into effect in 2014, prohibit insurance plan discrimination based on preexisting health conditions, offer accessible consumer assistance, and require employers to cover their employees. The ACA also requires health insurance plans to cover the following ten essential health benefits:
- Ambulatory and outpatient services
- Emergency services
- Maternity and natal care
- Mental health
- Prescription drugs
- Rehab services
- Lab tests
- Preventive and wellness services
- Pediatrics (including oral and vision care)
Private vs. Business Marketplaces
Marketplace plans exist for two groups: individuals/families and small business owners. A wide range of private plans are available for individuals and families to browse and select. Small business owners can utilize the Small Business Health Options Program (SHOP) to provide adequate health insurance for their employees. The SHOP Marketplace allows employers to shop for and enroll their employees in medical and dental insurance.
Interested in finding a new health plan from the Marketplace? Here are the first steps:
- Check your eligibility. Health insurance Marketplace plans are limited to U.S. residents, citizens or those with legal documentation, low-income families, and non-incarcerated individuals. Find out if you meet the qualifications here.
- Create an account. If eligible, the Marketplace requires you to make an account before enrolling in a healthcare plan. You may be redirected to your state’s individual marketplace if applicable. In order to find the right healthcare plan for you, you will need to provide information on your residence, income, and household size.
- Shop and enroll. Be sure to explore all options within the Marketplace before selecting your preferred healthcare plan. An enrollment application can be filed online or with the help of an in-person assister, an agent/broker, or a phone representative.
- Pay your first monthly premium. After enrollment, the health insurance coverage will not activate until you pay your first premium –– a monthly payment to your insurer. Insurance companies handle payment options differently, and instructions on how to do so can be found directly on your insurer’s website or information center. After the first payment is made, you can check the activity of your health insurance directly through the Marketplace.
Enrolling in Medicaid and/or Children’s Health Insurance Plan (CHIP) occurs year-round, but enrolling in private health plans is only possible during the Open Enrollment period. The Open Enrollment period typically runs between the beginning of November to mid-December. Individual state marketplace enrollment periods may vary, so be sure to check the exact dates for your state. If you miss this window, it is still possible to apply for healthcare coverage if you qualify for a Special Enrollment Period (SEP). Find out if you qualify for Special Enrollment here.
Learn more about the Open Enrollment period here***
Health Insurance Marketplace Plan Tiers
All health insurance marketplace plans fall within tiers based on their affordability. These tiers, known as “metal levels”, are determined by the percentage of medical costs the insurer will cover. Each tier splits costs between the individual and the insurer differently, resulting in varying premium and out-of-pocket costs. There are four plan tiers and one situational “catastrophic” tier.
- Bronze Tier: Bronze tier plans offer low monthly premium payments but high out-of-pocket costs. While premium payments are low, individuals with plans under this tier will have to pay 40 percent of medical expenses, and the insurer will cover 60 percent. Plans under this tier are a good choice for individuals who want to save extra by paying the lowest monthly premium, and may not need regular or continual medical care.
- Silver Tier: Silver tier plans offer extra savings and cost-sharing reductions for individuals who qualify. Find out if you qualify for cost-sharing reductions here. With a moderately-priced premium, the insurer will cover 70 percent of costs, and the individual will pay 30 percent. This plan is suitable for those willing to pay a fairly-priced premium for less financial burden on routine care costs.
- Gold Tier: Gold tier plans offer low routine care costs with a high monthly premium rate. Plans under this tier are a good choice for individuals who need regular or frequent routine care for a pre-existing medical condition. The monthly premium is a high cost, but the insurance company will pay 80 percent of accrued medical expenses.
- Platinum Tier: Platinum tier plans require the highest premium payment, but the lowest out-of-pocket costs for medical expenses. Plans under this tier are a good choice for individuals who want the most financial protection for routine care costs. The insurance company covers 90 percent of all medical costs.
- Catastrophic Tier: Catastrophic tier plans offer low premium rates, but little protection from expensive medical costs. Monthly premium payments are low but require individuals to pay the most routine medical expenses in the event of “catastrophic”, unforeseen medical emergencies. These plans are restricted to individuals under the age of 30 or others who cannot afford a Marketplace plan due to financial hardship.
As healthcare costs rise, you want to make sure you are getting the best healthcare for the price you pay. HealthPlanRate.com has a wide variety of plans available and gives you the option to compare rates. Find out below how to shop and select the right healthcare plan for you.
Other health coverage options are available outside of the federal Marketplace. Most are offered through private, for-profit, non-government companies. Cost-sharing plans are available to everyone and may be less expensive than other types of health insurance.
Cost-sharing health plans are designed to split costs between an individual and their insurer. Although most health costs will be covered by the insurance company, individuals will have to pay a portion of those costs in the form of deductibles, copayments, and/or coinsurance. A deductible is the amount an individual must pay for their own medical expenses before their insurance will begin covering the remaining costs. A copayment is a fixed dollar amount that a patient must pay to receive a medical service. Coinsurance is a fixed percentage of medical expenses that an individual must pay. When choosing a cost-sharing healthcare plan that’s right for you, look for a manageable balance between the monthly premium cost and the out-of-pocket costs that you will be responsible for paying.
Private Cost-Sharing Plan
Private cost-sharing plans are also available outside of the Marketplace. These plans can be found through private insurance companies, agents, brokers, and online health insurance sellers, and can offer you comparable coverage for a more affordable rate. Most plans operate similarly to traditional healthcare plans with the following exceptions:
- Monthly fee charge. Similar to a regular insurance premium, private insurers will charge a monthly fee to cover your health expenses.
- Member Responsible Shared Amount (MRSA). MRSAs are similar to traditional insurance deductibles. Out-of-pocket costs may be required for procedures, diagnostics, and specialist visits.
Who Is a Private Cost-Sharing Plan Right For?
A private cost-sharing plan would be right for those who cannot find suitable plans within the Marketplace. If you need specific medical services covered due to an existing condition, private cost-sharing plans can offer coverage for specific services. These plans may be right for you if you do not qualify for low-cost Marketplace plans, but still want to find affordable healthcare.
Christian Health Plans
For additional lowered healthcare costs, individuals may look into cost-sharing through Health Care Sharing Ministries (HCSM). Similar to a private cost-sharing plan, these Christian health plans aim to relieve the financial burden on individuals and families in need of medical care. Christian ministries are registered as non-profit organizations rather than for-profit insurance companies, and they allow people with similar beliefs and religious values to share medical expenses.
Unlike traditional health coverage plans, Christian health plans do not require members to pay a monthly premium for their individual medical needs. Instead, members pay a monthly share amount that contributes to a larger collective sum of funds. Members then submit their medical bills to the ministry, and the costs are covered by the collected monthly share payments of other members.
While Christian health plans are typically low-cost, members have limited protection. There is no guarantee or legal protection to ensure your medical bills will be paid, and disputes concerning cost-sharing are settled by the ministry itself. Christian health plans are not considered adequate insurance under the ACA requirements because some mandated services are not covered. Procedures or medical services that go against the ministry’s beliefs (i.e. contraception, sterilization, cosmetic surgery) will not be covered. Most HCSM plans do not include prescription drug coverage, and individuals may be responsible for paying those out-of-pocket costs.
Who Is a Christian Health Plan Right For?
Christian healthcare plans require potential members to meet a set of institutional standards. These standards are often set by religious traditions and require members to possess similar ideological beliefs and value systems. More traditional ministries may be stricter with their member selection process, if open to new members at all. Ministries may require potential members to live healthy lifestyles that don’t involve alcohol, drugs, or tobacco. They may also reject you if you possess any pre-existing medical conditions that require more expensive or frequent care. If your personal beliefs and lifestyle choices align with those of a particular HCSM, becoming a member and cost-sharing with others may be the right choice for you.
Indemnity plan charges work as a “fee-for-service.” Insurance companies pay a fixed amount of medical expenses on a per-incident basis, regardless of the final total cost. These fixed amounts are determined by Usual, Customary, and Reasonable (UCR) rates – the amounts that your local medical care providers charge for a given service. These plans require several out-of-pocket costs, along with an annual deductible, individuals under this plan may be required to pay upfront costs and submit a claim for reimbursement afterward.
Who Is an Indemnity Plan Right For?
If you’re someone who wants more control over your healthcare choices, an indemnity plan is right for you. Individuals with this type of plan experience more freedom and flexibility when choosing doctors, healthcare professionals, hospitals, and service providers. Without a designated primary care physician, you are allowed to visit any doctor of your choice and visit any specialist without a referral.
Health Insurance Questions
Finding the right health insurance plan can become an overwhelming and confusing task for anyone. With all the different options out there, the health insurance industry can be difficult to navigate. If you have questions, you’re not alone! At HealthPlanRate.com, we’ve tackled the most common healthcare questions that patients like you will want answers to.
What should I look for in my health insurance plan?
- It may be most helpful if you find a plan that covers the ten essential health benefits required under the ACA. However, you should examine your own medical needs and have a decent understanding of which medical services would be most conducive to your/your family’s personal health and well-being.
What does my plan cover?
- The medical services eligible for coverage vary across different insurance providers. Check with your own insurance provider to understand what your specific plan does and does not cover.
When can I begin using my health coverage?
- Depending on which health insurance plan you choose, coverage will be activated any time between when you enroll and when you pay your first monthly premium. Check with your insurance provider to understand the exact period your health coverage is active.
How do I use my health coverage?
- With most major health insurance plans, you will receive a medical insurance card. This card will have vital information about your personalized health plan, including the names of those covered by your plan, your plan type, a policy number, and a question hotline. Always bring it with you to first-time medical visits. You will not be denied healthcare if you do not have your health insurance card on your person, but carrying your card will simplify paperwork in the event of a medical emergency.
How do I know which medical service providers I can visit?
- Insurance providers will either supply a network of medical service providers or, in the case of an indemnity or HCSM plan, allow you to visit any medical service provider of your choice. Information on service providers can be found on your insurer’s website.
What happens if I don’t have my insurance card with me during a medical emergency?
- In a medical emergency, visit the closest hospital or urgent care center regardless of whether or not it’s in your insurer’s network. You will not be denied healthcare if you do not have your health insurance card with you in the event of an emergency. Insurance companies are legally prohibited from charging higher costs for out-of-network hospital visits for an emergency.
What are the benefits of having health insurance?
- Medical emergencies, procedures, prescription medications, and unexpected health expenses can amount up to thousands of dollars or more. With health insurance, you will be relieved of some or most of the financial burden that these costs can impose.