What is the best federal health insurance

Health insurance is a contract that requires an insurer to pay some or all of a person’s medical expenses in exchange for a monthly premium. “It’s to prevent you from hitting financial ruin should you run into an emergency,” says Molly Moore, co-founder and chief health plan officer at health insurance start-up Decent. “Some people get health insurance because they know they have ongoing health care issues that need to be taken care of, and some people get health insurance because they’re scared of something that could happen that they can’t plan for,” she says.

Going without health insurance coverage poses a risk to both your potential to get care and an even bigger risk to your personal finances, explains Noah Lang, chief executive officer and co-founder of Stride Health, a benefits platform for independent workers. People who aren’t insured (or who are under-insured) tend to be hesitant to get care, which can risk their health, he adds.

People who have health insurance are often more likely to go to the doctor when they need to because they know what it will cost, says Katie Roders Turner, executive director of the Family Healthcare Foundation in Tampa Bay, Florida. They tend to follow up on medical concerns their doctors flag, such as high blood pressure, before they turn into bigger problems, and they’re more likely to obtain necessary prescription drugs since they’re available at a more affordable rate.

Health Insurance Coverage

All health insurance plans sold on the federal marketplace are compliant with the Affordable Care Act (ACA), meaning they cover a set of 10 categories of services. These essential benefits that must be covered include:

Outpatient care
Emergency services
Hospitalization, such as for surgery and/or overnight stays
Pregnancy, maternity and newborn care before and after birth
Mental health care and substance use disorder services
Prescription drugs
Rehabilitative and habilitative services and devices for those with disabilities, injuries or chronic conditions
Laboratory services
Preventative and wellness services, including cervical cancer screening and HIV screening and counseling
Pediatric services, including vision and dental care

Outside these essential benefits, what a plan covers will vary, which is why it’s important to read the fine print.

The cost of health insurance varies dramatically, but certain factors might increase or lower your costs. According to HealthCare.gov, the five things that can increase your monthly premium are:

Your age. Premiums can be as much as three times higher for older people compared to younger enrollees.
Your location. Where you live impacts your premium, depending on factors like cost of living and state rules.
Tobacco use. People who use tobacco products can be charged up to 50% more compared to those who don’t.
Whether you’re seeking coverage as an individual or for a family. If you’re signing up for a plan that will also cover dependents, expect to be charged more.
Your plan category. There are four different “metal tiers” of plans you can choose from: bronze, silver, gold and platinum. These categories determine how you split your costs with your insurer. For example, bronze plans typically have lower monthly premiums and higher out-of-pocket costs than the other tiers, and platinum plans tend to have the highest premiums with the lowest out-of-pocket costs.

While health insurance is generally considered very expensive, there are ways to get help with paying for your coverage, says Lang. A recent Stride survey, found 80% of uninsured gig workers who didn’t think they could afford health insurance weren’t aware of tax credits that could assist with low-cost coverage. The American Rescue Plan Act of 2021 (also called the COVID-19 Stimulus Package) has made insurance much more affordable, he adds. Stride data shows nearly 40% of gig workers who enrolled in health insurance in 2021 were paying less than $1 a month.

The ACA offers financial assistance that reduces monthly premiums and out-of-pocket costs to help make health insurance more affordable. Premium tax credits, for example, are based on household income. “You probably qualify for assistance,” says Lang. With the American Rescue Plan Act of 2021, Americans who previously qualified for subsidies are eligible for more money and people who weren’t able to qualify previously now can, he adds.

There are some questions to ask yourself to ensure you’re choosing the best health insurance plan for you, including:

What will your total costs be? In addition to the monthly premium you pay your insurance company, consider your deductible and what your out-of-pocket costs might look like. “Some people would like to have premiums as cheap as possible and are fine with a higher deductible,” says Turner, while others prefer the opposite.
Are your favorite doctors “in network”? Each insurance company works with a certain network of providers. Before signing up for a plan, ensure that the doctors you want to see are included in the plan’s network. “As a mom, I don’t ever want to have my pediatrician not be in my network,” says Moore. “If you love your OBGYN or your family practice doctor, find out if they’re in network before you sign up, because it can make all the difference.”
What type of plan is it? If you sign up for a Health Maintenance Organization (HMO) plan, you generally won’t be covered if you seek out-of-network care unless it’s an emergency. If you pick a Point of Service (POS) plan, you’ll be required to get a referral from your primary care physician in order to see a specialist. The kind of plan you choose will affect your out-of-pocket costs.

If you’re struggling to figure out which plan is best for you, Turner suggests seeking the assistance of a health insurance navigator. These trained professionals can help you figure out if you qualify for any financial assistance and compare plans. To find a health insurance navigator, go to HealthCare.gov and enter your ZIP code. These services are “free, confidential and available to the public around the country,” says Turner.

Another option is to contact a health insurance broker. Doing so is typically free since they’re paid by health insurers, says Moore. “It’s really no risk to you to reach out,” she adds, and it can be a helpful way to feel more confident in your decision.

To determine the best health insurance companies, the Forbes Health editorial team evaluated insurance companies that offer plans nationwide in terms of:

How many states in which they provide coverage
Size of provider network
Number of plan types available
Lowest costs available in terms of physician and specialist copays (though they vary from plan to plan)
How agencies like A.M. Best ranked them in terms of their financial health (which impacts how reliable an insurer is when it comes to paying claims)
How agencies like the Better Business Bureau graded them in terms of consumer feedback

We focused exclusively on providing general summaries of the companies and their reputations. In order to provide specific plan recommendations accurately, it’s important to take into account the ZIP code and demographic details of the individual seeking insurance coverage. To do so, we recommend using healthcare.gov’s plan finder tool or seeking the expertise of an independent, agnostic insurance agent.

Open Enrollment for 2022 starts Monday, Nov. 1, 2021, and ends Saturday, Jan. 15, 2022. If you want your coverage to begin Jan. 1, 2022, you need to enroll in a plan by Dec.15, 2021.

“The driving factor for why health insurance is so expensive is that health care is so expensive,” says Louise Norris, a licensed health insurance agent based in Colorado and author of The Insider’s Guide to Obamacare’s Open Enrollment. “The price of health care in this country is really high.”

According to a 2020 report from the Kaiser Family Foundation, insurers said the reasons they had to increase premium costs included the continued cost of COVID-19 testing, the rebounding of medical services that had been delayed during the pandemic and morbidities related to foregone care.

If you’re signed up for an ACA-compliant plan, it will cover pediatric oral care. “But no, it will not necessarily always include adult dental,” says Turner. “That’s not considered one of the 10 essential health benefits.”

No, it is not illegal not to have health insurance, says Turner.

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