Buying Health Insurance? 4 Things You Need to Know

Buying Health Insurance? 4 Things You Need to Know

Dec 06 2014

Individual enrollment is open now through the Health Care Marketplace. It’s time to look at your options.

By: Joan Budden

The good news: the Affordable Care Act is helping people afford health care coverage. But, if you are looking to buy coverage through the Affordable Care Act, you still should consider all of your options before making a decision.

During this year’s open enrollment period, there are small nuances that can make a big difference in how much you pay for health insurance and when your coverage begins.

You should be aware of the following things before choosing or renewing a health care plan:

If you choose to let your insurance automatically renew, you could still see a rate increase, even if you keep your existing plan.

The health care market never stays the same. Every year, health insurance providers review their portfolio of plans and make adjustments. This means that there are new health plan options, new prices to consider and shifts in the subsidy or income tax credits offered.  That’s why it is always important to review your options.

For instance, the price of each health plan changes year to year. While more than 70 percent of Priority Health enrollees will see a price decrease, this isn’t an industry standard. As you may have seen in the news, many health insurance companies are raising their prices.

It’s also important to keep in mind that your income tax credit (which lowers your monthly premium) or federal subsidy changes year-to-year. You may want to determine what kind of cost break is available to you before making a decision. Or maybe you have more money to choose a different plan with better coverage than what you had last year.

It’s good practice to take time to review your options yearly.

The premium, or the monthly cost, is just one of many things to consider when comparing health plans.

When you review a health plan, make sure to check how much you’ll be required to pay out of your own pocket for services. Look at the co-pay for prescriptions and doctor’s visits. Evaluate the deductible – how much will you have to pay before your health plan begins covering services?

It’s also important to review all elements of a health plan. Does the company have a good reputation for customer service? If you have questions, will it be easy to get them answered?  Are your preferred physicians and hospitals offered as part of the network? Does the plan offer you flexibility to see a specialist without difficulty or added costs?

It’s critical that you take a look at the health care providers associated with the health plan you purchase. There are options available on the market that offer a limited network – which would require you to get approval from the insurance company to see a specialist or to pay higher costs or all of the costs if you should have to see a specialist or facility outside of the network.

Understanding how your family uses health care and what kind of service you will receive will impact your overall health care experience.

The open enrollment period is shorter this year in two ways.

Last year’s open enrollment lasted six months; this year it only will be open for three months. That window narrows even further if enrollees want a health plan in place Jan. 1 – those who want coverage by the start of the New Year must enroll by Dec. 15. The open enrollment period for 2015 officially closes on Feb. 15.

Don’t wait to buy insurance until you are sick.

Many individuals think that they can buy health insurance after they get sick. Unless you have a qualifying life event – like getting married, getting a new job or having a baby – you can only purchase health insurance during the open enrollment period. Even then, coverage does not begin until the following month.

Keep in mind that when you purchase a plan through the Marketplace– by paying your premium – you are locked-in to that health plan for the year. That’s why it is important to consider all of your options before making a decision.

Health insurance can be confusing. Being informed and researching appropriate individual plans can mean more options, better coverage and ultimately, save you money. Remember these four tips when choosing a plan that best suits your needs.

For more information on health insurance plans offered through Priority Health, visit

About the Author: Joan Budden is president and CEO at Priority Health. She is a seasoned and dynamic executive responsible for strategic marketing and product development nationwide. She oversees Market and Product Development, Sales, Marketing and Government Programs.