Your health insurance is probably one of the most important decisions you make on a yearly basis. Unfortunately, it can also be the most confusing! Check out this video to learn how to pick the best Marketplace Insurance Plan on Healthcare.gov.
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Marketplace Plans are a great option for comprehensive coverage, but there are so many decisions to make:
1. What’s the best health insurance for self employed people?
2. HDHP vs PPO
3. HDHP and HSA (Health Savings Account
4. Unemployment and Tax Credits
There are many factors to take into consideration when choosing a health insurance plan but basically it boils down to needs vs budget.
It’s actually much easier to understand our budget because it’s a hard number. There are a few costs you need to take into consideration:
Monthly Premiums
Deductibles
Cost Sharing Expenses (copays and coinsurance)
Out of Pocket Maximums
Your monthly premium is the amount you pay out of pocket to keep your insurance active. If you qualify for a tax credit, this is where you will see those monthly savings. The are four “metal levels” of coverage:
Bronze
Silver
Gold
Platinum
Generally speaking, bronze will have those lowest monthly premiums and platinum will have the highest. If you qualify for a tax credit, it will be applied to your monthly premium regardless of which plan you choose.
Then there is the deductible (the OOP before cost sharing) Under the ACA, all marketplace insurance plans must cover services deemed essential benefits before you meet your deductible. So for these services, you may have a copay or coinsurance as opposed to being responsible for the entirety of the cost even before your deductible is met. Some benefits are also covered at no cost.
Then there is the cost sharing aspect. Once you’ve met your deductible (or before if it is an “essential benefit”) you will pay for a portion of the cost and your insurance will pay for a portion. Even though there may be a pattern in the premiums and deductibles, the cost sharing is how the plans are delineated.
Bronze: 60/40
Silver: 70/30
Gold: 80/20
Platinum: 90/10
Finally, there are out of pocket maximums or limits. This is the max that you will pay out of pocket before your insurance covers 100% of the costs. In 2021, the max for an individual is $8,550 and for a family it’s $17,100. Your plan may offer lower limits and that will be indicated in the plan overview.
You’ll also need to identify your health needs.
1. How often do you and your family visit the doctor?
2. Other than the free services offered by marketplace plans, how often do you make use of the other listed “essential benefits”?
3. Do you have any conditions that require more frequent visits or in depth tests?
4. Do you have any specialty medical needs that might require a plan with more elaborate benefits?
5. Do you have any monthly prescriptions?
You’ll also need to understand the plan itself to determine which plans might best serve your needs:
1. Do you need the flexibility of a PPO? Or can you work with an HMO or EPO?
2. Do you have a network of doctors and hospitals you prefer? Do they accept your plan?
Picking an inexpensive plan may seem like a good idea, but if the doctors and benefits that you need to utilize are not covered by that plan, it won’t do you much good.
Additionally, picking a plan with a lower premium may seem budget friendly, but if you end up having to pay a larger deductible or larger copays for frequent visits, it may not actually be financially advantageous.
That may seem like a lot to take into consideration, but it doesn’t even end there! You’ll also need to think about:
1. Additional benefits such as dental and vision. Will you purchase a separate plan?
2. HSAs & HDHPs
3. Premium tax credits
If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or
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Good video
We are looking to change insurance but we need to know details 😊
creo que tengo un crush. also need health insurance lol. what do you think of us health group for self employed people?
I feel like insurance is big fat scam
I understand what you’re saying and thank you for the video. I’m not quite clear about the deductible. So do you pay the deductible before you can even see a doctor or is the healthcare system keeping a calculation on how much your spending and when it reaches the deductible amount then it goes into cost sharing. Also when does the premium kick in? I’m assuming you have to be notified at a later date on how much they’re giving you.
thank you, so much for this video!!!
I need help. For the past 5 years my husband and I have been on a HDHP plan with HSA(employer gives a monthly contribution of $50) we pay $156/month (deductible of 3,000/fam and 9,000/fam for out of pocket). Within these 5 years my husband had a kidney transplant and has medication that he’ll be on for life as well as regular Dr visits and specialist visits. Lately we’ve been thinking about having a child and whether or not we should switch to an PPO. The PPO would cost us $216 per month (2,400 deductible/fam and 12,400 out of pocket/fam)
Can you help me decide or what should I be focusing on. I’m so lost and scared of change but the PPO would be about$35 for copay at Dr so it sounds like it might be better bu
$30 for an aspirin at a hospital….This is all a an elaborate scam. When we get weak and sick the vultures are right there to steal your house and cripple you financially. But let's keep worrying about tick tock crap..
Help, here is my situation, household of 2, only 1 income =90k, current employer sponsored insurance =800 per month with both in household. How can I remove one person from company insurance that will reduce monthly to 160 and get separate insurance for other household member.
Why can't we simplify taxes and health insurance?
Hello. Are there marketplace options for disabled veterans who have VA Health benefits, but would like to have a back up plan?
great vid lot of info..
ot is all ridiculous confusing..on purpose to screw over working people and Elderly.. suckks stinks.. no right.. while super rich Docs Hospitals Insurance Exec making big bank $$$ off it driving their Mercedes BMWs Porsche Tesla suv to their 2nd beach resort homes on vacation all summer
yeh it's a Great system here in great ole USA.
What a ScrewJob
anyhow.. soon have to get on Medicare.. turning 65.. but see Part A is free i guess.. worked 40 yrs..
but Part B is huge $164.90/mo Can't afford that no way No job. No income. No way !!
in MA can I get Adv plan or MediGap or sthing.. idunno
to help pay ..tax credit ? to pay Part B and or Part D too.
(is that Part C then kinda?)
so stupid confusing.
MC rly rly rly Suckkks charging Everybody $164.90 + higher for US govmint bs insurance.
What a Ripppoff.. and get very little for it to boot huge huge deductibles.. copays etcetcetc.
What a load crap. smfffh
can't bevlieve it
Americans Healthcare systems so ridiculously expensive, yet they loaded plane full of money and wasting across the world, while citizens struggle with their basic need.
I’ll never understand how anybody can be against universal health insurance (getting rid of this insurance mess)
Thank you for explaining this in a simpler way to understand.
Good day. My parents apply for insurance in the marketplace. What happens if they overreported the income in marketplace? For example, they estimated the 2023 income to be $26,000 and it turns out that they will not make any money this year. So how much do they have to pay back to marketplace, like all of the Premium tax credit available per month x 12 months?
How are out of network hospital and doctor charges considered against the out of pocket max in the case of emergency care (out of area)? Are they not considered at all?
I don't need 99%. I don't need like one percent of coverage and I want the rest put back in my pocket
Can you explain if you are veteran and you only have medicine expenses? But you need other medicine expenses that are not covered as of yet, but there are things going on to change what
I want a card that covers THC hemp oil. High levels of hemp oil that grow new brain cells and new nervous cell systems. That's been covered up for a very long Tare. You ready for that
I want the health care problem that covers my gym cost and my sacred oil. And gives me special discounts because I am a Marine Corps veteran. You know, things like that. Do you understand what i'm talking about
Not only are the essential benefits covered up, but also the murder of Stanley Myers and many other murders. To cover all this s*** up. Oh, it's deeply connected on the highest levels. You understand that and as a leader of the truth movement, I expose that
Who am I to disagree? Travel the world of the seventies and sees
As a 100% disabled, veteran not being approved from my disabilities that I went through while I was in the Marine Corps. That's one warfare, and then there's the other one with this kind of healthcare program
Veterans should get platinum and it should be paid for 100% plus a monthly stipend, a nasty hitting the surface. I'm not talking about benefits because these cards should have extra benefits on them as well. Like free membership to Jim's the coverage of hemp oil with THC.
I just found this video. Great info. Several years ago, when it was way cheaper I had a platinum plan. Thank God I chose it because that year I almost died and had to have a transplant. Since then, I can no longer afford platinum but switched to Gold due to special medical needs. It is costly with student loans, but my employer plan is limited on what medications it has and starting over with prior authorizations is stressful. Not sure I’m doing the right thing here, but my gut is telling me to stick with what I have for now.
What about alternative health insurance approaches like healthshares, short term insurance, and members clubs like CYA?
thank you young lady very usefull info.
My mom just called me panicking. One of her nieces, my cousins, needs insurance. She aged out if medicaid, only works part time and has health issues.
I felt completely useless. Although I work in a doctors office I know nothing about how to get insurance other than getting it through your employer or seeing if you qualify for Medicaid.
Anyway Im always on utube so I did a search and found this video.
I sent her the number for iHealthbrokers. Theres a lot that goes into finding insurance why not have a broker help with the process. Ill be keeping the number for myself should I need it.
Thanks for this video ❤
Please explain the first part of your video again. Am I understanding correctly, to purchase insurance we can go directly through an insurance company, directly to Healthcare.gov or through an agent. How is the agent paid when a consumer contacts them? Is it a commission paid by the consumer added to the insurance premium each month or a one time fee paid by consumer or how do I pay the person helping me select a health plan? Thank you so much for your answer in advance and for the great videos.