Most of us at some point in time have had to select a health insurance plan. There are many factors to consider in order to select the plan that is right for you. At Mainline insurance we conduct a full needs assessment before we even begin to look at plans. That way we show you plans that make sense and remove the plans that are not really an appropriate option.
A simple needs assessment is conducted in a few minutes. We evaluate your health, income, age, eligibility and provider network preferences.
First is your overall health, how often do you see a doctor? once a year? once a month? Do you see any specialists or take any medications on a regular basis. If so are these medications generic or specialty drugs? Let's say for example you are healthy, a physical once a year and the occasional cold. It may make sense for you to lean towards a lower premium plan at the catastrophic, bronze or silver level. All ACA plans include free preventative care (physical, blood work, usually a free doctor visit) For a healthy individual this may be suitable for your needs and save you money with lower monthly premiums while still providing max out of pocket protection in the event of something catastrophic happening.
Alternatively, maybe you see a doctor often, perhaps you are diabetic. Typically, people in this situation require multiple specialist visits a year, monthly medication and durable medical equipment. For these individuals it makes sense to do a platinum level plan. Although premiums are much higher, the max out of pocket is lower and in the long run you will actually save money as you engage the healthcare system.
In the individual market, income is important. For an individual in New York earning between $16k and $46k/year you will likely qualify for subsidies in the form of Advanced Premium Tax Credits. These APTCs will reduce your monthly premiums by an amount dependent on you income. It is important to consult a professional so they can assess your income accurately and get you the appropriate tax credit amount.
Age does make a difference, If you are younger than 30 you have plan options that are relatively inexpensive, so if you are healthy they may be the most economical option and provide only the coverage you need instead of paying for services you won't use. For older individuals you may think, "Well I'm healthy, I don't need a high level plan." This may be true, but keep in mind as you get older, things break, that's life unfortunately. In that case it may be worth it to have the security of a gold or platinum plan.
Eligibility is a big factor. During Open Enrollment, which is between November and February anyone can freely purchase or change health insurance plans without restriction. However, if you are outside of this time period in what's call Special Enrollment, you will need to have what is called a Qualifying Life Event. This is typically an involuntary loss of coverage (ex. lost a job, lost coverage). There are other's but we will save them for another day.
Finally, we look at provider network. If you are seeing a doctor or prefer certain doctors and hospitals its important we consider only plans that cover those physicians. At Mainline we have the resources to determine which doctors are in a plans network and which ones are not. Let us do the research for you.
If this all seems too complicated and too labor intensive don't worry, we have licensed brokers standing by ready to assess your needs and find the plan that's right for you.
Mainline President Vincent Reda is a Healthcare specialist with 40 years of experience in providing healthcare coverage to individuals and organizations.