Health insurance is important because the cost of even the most basic health care is gradually increasing in America and Americans are spending a major part of their incomes on healthcare. Health insurance is an insurance that covers the cost of an individual’s and his family’s medical care. Just like any other insurance you choose a plan, get a health insurance quote, pay a premium and the insurer, in return, agrees to pay for your covered medical care. Health insurance also covers doctor’s visits and routine health check-ups that come under preventive care.

There are many costs involved in a health insurance quote and it doesn’t fully cover your entire medical expenditure. Firstly there is a monthly premium to be paid to the insurer. In addition, there is a fixed amount limit called deductible or out of pocket limit which you pay yourself. After you reach the out-of-pocket limit, health insurer will start sharing your healthcare costs. But you still have to pay cost sharing called co-payment and co-insurance. Co-payment is that percentage of cost that will be paid by you for doctor visits. Co-insurance is the percentage you pay for medical procedures and hospital stays. The ways in which a health insurance company shares your medical cost, constitutes major features of your health insurance quote that you should be aware of.

Health insurance quotes must match certain affordability standards, as well as state rules in order to be a part of a government-run health insurance exchange. Such plans are called On-exchange plans. There are off-exchange plans also which are not sold on government-run exchanges, but they must also offer the basic medical benefits and meet certain federal standards in order to qualify as an affordable health insurance plan. These consumer protections removed loopholes that created financial problems for policyholders in the past.

In order to provide affordable health insurance to all Americans, Affordable Care Act (the ACA, also known as Obamacare), was enacted in March 2010. It states that all American citizens must have qualifying health coverage. It offers tax subsidy in form of financial assistance from federal government that helps you pay the cost of health insurance. If you don’t buy a health insurance, you are required to pay a penalty on your federal tax return called individual responsibility payment. The tax fee is charged in one of the two ways:

1. 2.5% of household income or
2. $695 per adult and $347.50 per child (minor)

You’ll pay whichever is higher.

It is mandatory for everyone to buy health insurance unless one qualifies for a hardship exemption. But many people think that health insurance quote is too expensive or they don’t need health insurance at all. Not buying health insurance means tax penalties, dealing with unexpected medical emergency would be very expensive and getting preventive and primary care will become expensive as well. It is important to be careful and prepared otherwise a small health issue can turn into a financial disaster because medical bills can lead to many financial problems (e.g., bankruptcy and home foreclosure).

There are additional considerations for buying health insurance quote under one of the following groups, let us have a look

Family:

A family with children may have more frequent visits to the doctor or urgent care. It is therefore important to buy an affordable health insurance which has low deductible, copayments, and coinsurance payments otherwise you will be paying out-of-pocket for a simple doctor’s visit. It is important to note that a family health insurance quote may include a family deductible in addition to individual deductibles for each family member. Individual deductibles are lower than the family deductible. Once an individual reaches their individual deductible, their health insurance plan starts paying for them. But once the family deductible is reached, health insurance starts paying for every member of the family, even if not an individual has reached his deductible.

Student:

An individual can stay on a parent’s health insurance plan until he is 26-years-old, so no need to buy health insurance quote if parents allow you to stay on their plan. Universities also offer affordable health insurance plans which are a good option for out of state students as their parent’s plan may not work in that state.

Self-employed:

Individuals who have left their full time jobs to become self-employed can use COBRA (Consolidated Omnibus Budget Reconciliation Act) to continue with their previous employer’s coverage until they find a new plan. If it’s not open enrollment, they can qualify for a special enrollment period to shop on the marketplace. As self-employed individuals may have variable monthly income, premiums should be affordable. They should remember that premiums are also tax deductible. For frequent travelers, a plan should allow them to seek out of network providers like PPO/POS plans.

Low income:

Medicaid is a public health insurance plan for low income individuals and families. If an individual’s income falls between 100% and 400% of the federal poverty line, he can qualify for a subsidy from the health insurance marketplace and can get a reasonably affordable health insurance like catastrophic plans which have low premiums but high deductibles. It can protect from the cost of serious illnesses and accidents.

Veteran:

Veterans qualify for health care through the U.S. Department of Veterans Affairs (VA). The Affordable Care Act does not modify VA health benefits. An individual qualifying for VA health benefits does not need to purchase an additional health insurance quote to meet up the Affordable Care Act’s health insurance mandate. Additionally he can use coverage from his private-sector employer also at the same time.

Pregnant:

All health insurance quotes cover pregnancy and childbirth related services. Maternity care and childbirth are one of the ten essential benefits that every health insurance plan is required to offer under the ACA. Maternity coverage is available for all women who are or may become pregnant. As maternity coverage has become a mandatory benefit anyone seeking it may get health insurance quotes in her state and choose a plan. Birth of a child is a qualifying event for a special enrollment period of 60 days in which you can enroll in a new plan or switch plans. In some states like New York, becoming pregnant also qualifies for a special enrollment period. Medicaid and CHIP also covers maternity care and childbirth.

Senior citizen:

An individual above the age of 65 qualifies for Medicare which is a federal program designed to cover cost of health care in old age. Supplemental insurance like Medigap is also available to help cover deductibles, copayments and coinsurances.

Military:

For active military personal, healthcare is covered by TRICARE for which no additional health insurance quote is covered.

Married without kids:

Such individuals don’t need family health insurances. They can buy individual plans from different companies. One can be dependent on the employer’s health insurance plans if that is available.

In United States, there are two types of health insurance: public health insurance (like Medicaid, Medicare, and CHIP) and private health insurance. Public health insurance provides coverage for senior citizens, children and low income families who meet qualifying criteria. Private health insurance is the primary source of health coverage, which is purchased through a marketplace or is available from an employer. State exchanges and the federal exchange offer both public health insurance and private health insurance to consumers.

On-exchange private health insurance quote

On-exchange private health insurance policies are plans that are sold on government-run exchanges, like a state exchange or the federal exchange (Healthcare.gov). On-exchange plans are required to cover the ten essential benefits, along with any additional services that are made compulsory by your state government. Additionally, an insurance company wants to participate in a government-run exchange, it must offer plans at every metal category (like platinum, gold, silver and bronze levels). On-exchange private plans are the only plans which offer government subsidies for qualifying applicants in the form of premium tax credits and cost-sharing reductions. Note: President Donald Trump declared that cost-sharing reductions will be discontinued to insurers, which has led to increased premiums, particularly on silver plans, this year.

Off-exchange private health insurance quote

Off-exchange private health insurance policies are plans that are sold in the open market, either directly by the health insurance company, through a third-party broker, or a privately-run health insurance marketplace. Off-exchange plans must also cover the ten essential benefits and follow other rules defined by the Affordable Care Act. These plans offer greater plan choice for those who don’t qualify for a subsidy. An off-exchange plan provides an insurer more flexibility. For example, insurers can offer just one type of health insurance plan because they don’t have to offer a plan at every metal tier. At the end of the day, if you’re seeking private health insurance and ineligible for a premium tax credit, off-exchange plans gives you more options at potentially lower price points.

Employer-provided health insurance quotes

Employer-provided health insurance quotes, also called group plans, are private plans sponsored and managed by your employer. Employer-provided plans follow the same rules as other private insurance plans and likewise cover the ten essential benefits. If you’re eligible for an employer-provided plan, you do not need additional coverage through the marketplace. Contact your human resources department for more detailed information about your plan.

Short-term health insurance quotes

Short-term health insurance quotes are not qualified health plans under ACA, as they provide limited health care coverage for a temporary gap in coverage. It is very important to note that short-term health insurance plan’s time period that you’re covered for will be ‘uninsured’ time for the purposes of the ACA mandate (and avoiding the tax penalty). However, short-term health insurance may still be useful to cover a short coverage gap of one or two months – for example, if you are looking for a new job or a new job has a waiting period before your health insurance starts. Many large health insurers offer short-term plans. But remember that short-term health insurance may have limits that regular health insurance does not have (e.g., caps on annual benefits paid). However, for substitute coverage, these plans are a good option.

Medicare

Medicare is a federal health insurance program for Americans above the age of 65 under Social Security Administration. Anyone above the age of 65 or younger with disability can afford health insurance quote, regardless of their income level. There are four parts to Medicare that cover different healthcare services. Part A covers hospital stays with food and tests. Part B covers physician services, visiting nurse, diagnostic tests, vaccinations, dialysis and other outpatient hospital procedures. Part C is the medical advantage plan and Part D provides prescription drug coverage. Parts A and B are paid for by taxes, while the other two parts, Parts C and D are paid for by the program participant. Anyone above the age of 65 or with a disability can apply for Medicare through state exchange or Healthcare.gov.

Medicaid and the Children’s Health Insurance Program (CHIP)

Medicaid and CHIP are low-cost or free health plans that cover many medical services. Medicaid is a program formed by federal government but administered by state to cover medical services for low-income families and individuals. Medicaid has eligibility requirements to meet federal income and asset standards that are set on a state-by-state basis, but it is primarily designed for people in need such as aged, blind, disabled and single parent families having low incomes and low liquid assets. You can check your eligibility for Medicaid through Healthcare.gov or your state exchange.

The Children’s Health Insurance Program (CHIP) is a health plan funded jointly by federal and state program that is similar to Medicaid, provides health coverage to children below the age of 18. The program is primarily intended at children in families who have incomes ranging from low to modest to afford private health insurance quotes. It includes a large number of kids having special needs. It offers services focused particularly at children’s health and developmental needs. To avail CHIP you can check if you qualify and apply on Healthcare.gov or your state’s exchange.

All the major health insurance quotes under ACA come in different formats. All private health insurance plans, whether they’re on-exchange or off-exchange, work in partnership with networks of healthcare providers. The ways these plans work with the networks vary significantly. Let us understand these plans, their benefits and the differences between them.

HMO: Health Maintenance Organization

It is a group health insurance policy in which employees have a lower out of pocket expenses. HMO plans are the least flexible type of plan when it comes to the choice of hospitals and physicians. If you have an HMO plan, you’ll be asked to choose a primary care physician (PCP) that is in the policy’s network of service providers. All of your care will be coordinated by your PCP, and it provides a broader range of services than other plans. To consult a specialist you’ll need a referral from your PCP. Any out-of-network healthcare costs are not covered by HMOs. HMO plans have cheaper premiums than other types of private health insurance quotes.

PPO: Preferred Provider Organization

It is also a group insurance policy. PPO plans are the most flexible type of plan when it comes to the choice of hospitals and physicians. Employees are required to access company’s network of providers and getting care from outside the plan’s network will incur additional out of pocket cost. Normally, you have the option between choosing between an in-network doctor, who can see you at a lower cost, or an out-of-network doctor at a higher cost. You do not need a referral to see a specialist, you are not required to choose a primary care physician (some states, like California, may require you to choose a primary care physician). PPO plans normally have more expensive premiums than other types of private health insurance quotes.

EPO: Exclusive Provider Organization

EPO plans are group health plans that are a mix between HMO plans and PPO plans. EPO plans present you the option of seeing a specialist without a referral. However, EPO plans do not cover out-of-network physicians except for emergencies. EPO plans normally have more expensive premiums than HMOs, but less expensive premiums than PPOs.

POS: Point of Service

POS plans also combine features of HMO and PPO plans. Employees have a primary care provider on an HMO-style network that can coordinate their health care. Employees also have access to a PPO-style network with out-of-network options at a higher cost. The HMO network will be more affordable, and you will need to get a referral to see HMO specialists. POS plans normally have more expensive premiums than pure HMOs, but less expensive premiums than PPOs.

Remember, earlier in this article we talked about how all health insurance plans split some of the costs between the insurer and the consumer? Metal tiers are categories that indicate how the cost of the health care services is divided between the insurer and the consumer. These tiers are very helpful in comparing plans before finally choosing one. Many people often get confused because they think metal tiers indicate the quality of the plan or the service they’ll receive, which isn’t the case.

Here’s how metal tiers break down the cost of health insurance quotes between consumer and insurer

• Bronze – 40% consumer / 60% insurer
• Silver – 30% consumer / 70% insurer
• Gold – 20% consumer / 80% insurer
• Platinum – 10% consumer / 90% insurer

These percentages are derived from a combination of deductible, coinsurance, and copayments, as per the specific structure of the plan, based on the expected average use of the plan. These percentages neither take premiums into account nor do they represent the exact amount that you’ll actually pay for medical services.

Among these tiers, Bronze plans have the lowest monthly premiums and Platinum have the highest, with Silver and Gold occupying the price points in between. As you can see from the cost-sharing split above, Bronze plan premiums are cheaper because the consumer pays more out of pocket for healthcare services. If you frequently utilize healthcare services, you’ll probably end up paying more out-of-pocket if you choose a Bronze plan, even though it has a lower premium. But the same bronze plan is suitable for those who rarely go to the doctor. For a plan in higher tier you can use a health insurance premium subsidy to help make it an affordable health insurance plan which will save you money.

Finally, there’s a fifth type of health insurance called catastrophic plans that are available in the marketplace. Catastrophic plans have very high deductibles – often, the deductible is equivalent to the out-of-pocket maximum limit – which means they’re really only useful for preventing an accident or a sudden illness from causing you to go into severe debt. Catastrophic plans are only available for people under 30 or people with a hardship exemption. There is no subsidy available on catastrophic plan premiums, but catastrophic plans do count as qualifying health care when it comes to the health insurance mandate.

In order to get proper healthcare coverage at a reasonable cost it is necessary to understand the working of health insurance plans and what goes into deciding the cost of a health insurance quote. Following are the key features that decide how much you’re actually going to pay for healthcare.

Premium

Premium is the amount you pay to the insurer monthly, quarterly, biannually and annually. Provided that you pay the premium, you remain covered under the health insurance plan. Every month, you pay a premium to a health insurance company in order to access a health insurance plan. Choosing a plan with lower premiums will mean that you’ll pay more out-of-pocket if you need to see a doctor. On the other hand plans with higher premiums mean low deductibles; low out of pocket costs and better plan services. The length of the policy period determines the amount of premium and other out of pocket costs.

Deductible

A deductible is the amount you need to pay for healthcare services out-of-pocket before your health insurance starts to pay for the services you are covered. In most plans, once you pay your deductible, your health insurance company starts to pay based on the copayments and coinsurance, that apply to your plan, to split costs with you (up to the out-of-pocket max, after which the plan pays for 100% of services). Plans with lower premiums generally tend to have higher deductibles. So lower premium plans are not the most affordable health insurance plans.

Maximum out-of-pocket amount

The maximum out-of-pocket amount, also called the out-of-pocket limit, is the amount of money you pay for deductibles and coinsurance charges in a year before the insurance company starts to pay for covered healthcare services. Monthly premiums do not count. The maximum out-of-pocket limit for 2018 is $6,650 for individual plans and $13,300 for family plans; plans with higher premiums have lower out-of-pocket limits. Note that the maximum out-of-pocket is a consumer protection limit enforced under the ACA; previously plans didn’t have a limit what a person would be required to spend on healthcare services. This often meant that insured people who had to undergo very expensive treatments (e.g., for cancer or lifesaving surgery) could face unlimited medical bills.

Critical illness insurance

Critical illness insurance is a type of health insurance product that helps you pay for expensive illnesses that affect you and your ability to earn money for years. It may also lead to loss of income due to inability to work. For example, Alzheimer’s disease, cancer, and stroke are three diseases that a critical illness insurance policy may cover. Each critical illness policy has its own list of illnesses that it will cover. If you are diagnosed with one of these illnesses while you’re a policyholder, your insurer will pay you a lump sum cash payment. If you own a term life insurance policy, you can also get a critical illness rider attached to your life insurance policy for lesser money than a separate critical illness plan.

The Affordable Care Act, also known as Obamacare, made it compulsory to cover certain healthcare services as a requirement for all health insurance plans available to consumers. These required services are known as the ten essential benefits. These ten categories o

• Ambulatory patient services (outpatient care that you can receive without being admitted to a hospital)
• Emergency services
• Hospitalization for surgery, overnight stays, and other conditions
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices (treatment and devices that help people gain or recover mental and physical skills after an injury, disability, or onset of a chronic condition and help them improve skills for daily functioning)
• Laboratory services
• Preventive and wellness services, as well as chronic disease management
• Pediatric services, including oral and vision coverage for children

Note that these are categories of services, and the minimum basic requirement for affordable health insurance. The specific services offered within these categories may differ from state to state. Typically states require that health plans offer more services without annual dollar cap to their customers, rather than restricting services under these categories. State, federal, and private exchanges will show you exactly which services are covered in your health insurance quote before you apply.

Preventative care

Preventive care is the care you get to prevent illness or diseases. All health insurance quotes on government-run marketplaces offer a set of preventative healthcare services, such as vaccinations and screening tests, at no cost to plan members (even if you haven’t reached your deductible). As of 2017, following are the 18 free preventative services for all adults, as outlined by Healthcare.gov:

• Abdominal aortic aneurysm one-time screening
• Alcohol misuse screening and counseling
• Aspirin use to prevent cardiovascular disease
• Blood pressure screening
• Cholesterol screening
• Colorectal cancer screening
• Depression screening
• Diabetes (Type 2) screening
• Diet counseling
• Hepatitis B screening
• Hepatitis C screening
• HIV screening
• Immunization vaccines
• Lung cancer screening
• Obesity screening and counseling
• Sexually transmitted infection prevention counseling
• Syphilis screening
• Tobacco use screening and cessation interventions

Note that some of these screenings may only be for specific age groups. These services are free if provided by the doctor or provider in your plan’s network. Check your plan or talk to your insurer to check which preventative services are free for you.

In addition, women and children also have their own set of preventative care benefits. For women, there are many free preventative care benefits related to pregnancy, breastfeeding, and contraception, as well as gender-specific cancers and sexually transmitted diseases. For children, free preventative care is more focused on vaccinations, developmental disorders and behavioral issues, as well as screenings for common chronic illnesses that can develop in children.

According to the Affordable Care Act, there are only five factors that go into setting your premium:

• Your age
• Your location
• Whether or not you use tobacco
• Individual vs. a family plan
• Your plan category (Bronze, Silver, Gold, Platinum, or Catastrophic)

Health insurance companies are not permitted to take your gender or your current or past health history into account when setting your premium.

Health insurance premiums on the Affordable Care Act’s marketplaces have increased steadily since 2016, largely due to political uncertainty around the law. However, nearly 85% of the roughly 10 million people who purchased healthcare through marketplaces received tax credit subsidies in 2016, so it's uncertain how severely premium increases are affecting shoppers directly.

When it comes to buying a health insurance quote, however, there are more factors involved just the monthly premium. As we can see in the sections above, health insurance is only one part of your total expenditure on healthcare services. As a matter of fact premiums are inversely proportional to out of pocket costs like, if you frequently visit a doctor and you buy a plan with a high deductible and low monthly premium, it’s likely that you’ll spend more money overall than if you bought a plan with higher premiums, a lower deductible, and lower copayments and coinsurance payments. So low premium does not guarantee a low health insurance quote.

A premium tax credit may enable you afford the right health insurance quote. A premium tax credit is a tax credit that helps you reduce the cost of your monthly premiums by applying in advance of your tax return. You can also avail the tax credit when you file your yearly tax return. Tax credits or subsidies are only available to individuals and families within a certain income range – between 100% and 400% of the federal poverty line in your state.

Premium tax credits are only available on marketplace health insurance quotes and cannot be used on public health insurance quotes, catastrophic health insurance quotes, or off-exchange private health insurance quotes.

Commonly, there is only one period of time in which you are allowed to shop for a new health insurance quote on a government-run or private marketplace. This is the called the open enrollment period. You cannot shop for a health insurance quote outside of the open enrollment period unless you qualify for a special enrollment period.

These enrollment periods are defined in order to enforce the health insurance mandate. Because health insurance companies must cover people regardless of their pre-existing conditions. The Affordable Care Act mandates that everyone buys health insurance, even if they believe they are healthy or do not need health insurance. Premiums from healthier consumers who don’t use a lot of healthcare services help offset the cost of covering people who do need to use more health services, thus making health insurance quotes available for everyone.