New to Health Insurance? The Top 4 Questions to Ask

By Sally Poblete, Founder and CEO, Wellthie

Whether it’s finding out the price of your deductible or figuring out what the word deductible means, one thing’s for sure: health insurance can be complicated. Purchasing a health plan is a large financial decision impacting you and your family, and is critical to maintaining good health. This year while shopping for a health plan, make sure you are asking the right questions:

1. What are my options?
2. How do I get it?
3. What will it cost?
4. How do I use it?

What are my options?
There are many different ways in which to obtain coverage. If your employer offers insurance options, they will contribute to the cost of your insurance and help you enroll in a plan that meets all requirements under the Affordable Care Act (ACA). If your employer does not cover you, you will be able to buy individual coverage. In New York, individuals can shop for an individual health insurance plan through an insurance company, broker or through the New York State of Health.

Your age and income determine what health insurance you’re eligible for:

  • Individuals under 30 can also receive subsidized plans covering basic services at minimal cost to them, while those under 29 have the option of staying on their parent’s health insurance plan in the State of New York.
  • Typically, those 65 and over are eligible to receive coverage through Medicare.
  • Those under 65 with a disability may also qualify for Medicare.
  • Single New Yorkers whose income is at or under $16,105 per year and families of two earning $21,707 per year are eligible for Medicaid, which in many cases is $0/month.

Check your EmblemHealth individual options, including the potential tax credits you may qualify for, through the Affordable Care Advisor.

How do I get it?
If you are eligible for Medicare, you can purchase a 2016 plan during the current Medicare Open Enrollment period now through December 7. You can enroll in an EmblemHealth Medicare Advantage Plan or through the CMS Medicare Online Enrollment Center. For those shopping for individual plans, Open Enrollment begins November 1 and lasts until January 31, 2016. Start shopping around to find the best plan for you and your family now. Take a look at EmblemHealth’s Plans for 2016 to make your purchase and enrollment process headache free. To view options from all carriers, you can go to New York State of Health.

What will it cost?
In New York, the cost of your plan is determined by where you live; who is covered (just you, you and your spouse, you and your kids, or your whole family); and the type of plan you purchase. In other states, price is also influenced by your age and whether or not you use tobacco.

Based on your household income, you may qualify for financial help. For example, In New York, financial help is available for individuals making under $47,080 per year, or $97,000 for a family of four. According to U.S. Department of Health and Human Services, last year the average consumer received $268 in tax credits a month!. However, there are more than just the upfront costs of a plan to consider. Take the time to consider all your options and read through the “5 Things to Consider When Choosing a Health Plan.”

How do I use it?
Once you purchase a health plan, you will be covered for a year. The great news is that certain essential benefits are covered at zero cost — these include preventive services like counseling, screening, and vaccines. Although all health plans cover the essential benefits, you will need to look at a plan’s Summary of Benefits and Coverage (SBC) to see what additional services are covered. Your SBC will show what is covered by your insurance in detail, including how much you may need to pay out of pocket for each health care service, if at all. Last but not least, you should also take a look at where you can use your health plan. All health plans include a network of providers — doctors, hospitals and clinics. Not all plans help pay for health care services you receive outside of their provider network, so make sure your preferred physicians and hospitals accept the heath plan you are considering.

By asking these right questions, you will get the right answers, security in your decision, and a health plan designed to fit your lifestyle.

 Wellthie is a health care technology company offering software-based solutions that help simplify health insurance.