One week left to sign up for the ACA/Obamacare and I have no idea about deductibles or coinsurance or any of these terms

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One week left to sign up for the ACA/Obamacare and I have no idea about deductibles or coinsurance or any of these terms. 26 Y.O (mostly) healthy male who is looking for a plan that focuses on preventative care.

I would provide a more specific question but I’m really not sure where to begin. Usually, I go to the doctors once a year for a checkup. I went to the ER for a severe stomach bug 3 years ago. I’d like to do 2 dental cleanings this year and have to get my wisdom teeth out, too.

Because I never really used the insurance I had and it was a family plan, I never got a feel for what a good/bad plan entails.

What should I be looking for and what should I look out for?”

Asked December 8, 2017 by Anupriya Basu

1 Answer

Attempting to understand US healthcare can be confusing and even overwhelming. It may be easiest to start with explaining the basics and work our way toward finding a healthcare plan that will fit your needs best.

The Affordable Care Act, sometimes referred to as Obamacare or the ACA has changed the way that health insurance works. If you don't get healthcare coverage from your employer there are a few options that you'll have. What to look for and avoid will really depend on where you live and what circumstances surround you as an individual. Essentially, you'll want to find the least expensive healthcare coverage with a reliable company that has a low deductible and will cover you adequately.

What is Obamacare?

Obamacare, or the ACA, changed quite a few things about the way that healthcare operates in the United States. It took a very long time to draft and pass this act through Congress. There are many complicated concepts that have been addressed by the ACA and understanding what some of the basic changes are is important.

Because of the ACA, insurance companies are no longer able to cancel health insurance if a customer becomes sick or injured. It also protects from other sorts of discrimination in the healthcare industry.
Key provisions addressed within the ACA have to do with the protection of those with pre-existing medical conditions who are otherwise unable to find insurance at a reasonable rate. In the past, pre-existing conditions may have excluded individuals from access to most healthcare or health insurance programs. The ACA helped to ensure that individuals in this category would be able to find insurance at a rate that they would be able to more easily afford.

Additionally, the ACA extended the age at which younger individuals could stay on the insurance plans of their parents. This is helpful to college students or individuals who are not yet able to purchase health insurance of their own.

The ACA also makes it mandatory to carry health insurance at all times. Those who are not carrying health insurance are susceptible to certain fines.

One of the effects of the ACA is that it has begun to cause a rise in the cost of health insurance prices.
Since health insurance is required by law and not always offered by your employer, Obamacare is a way for individuals to gain access to healthcare coverage that they can afford. Before you look at enrolling with an insurance company, it may be a good idea to find out if you qualify for Obamacare.

How do you know if you will qualify for Obamacare?

If you don't have health insurance, and it isn't offered by your employer or you are unemployed, you may qualify for Obamacare. There are a few steps to see if you qualify. Obamacare offers a "Do You Qualify" flowchart. During the open enrollment periods, you may enroll in Obamacare if you qualify. For 2017, the open enrollment period is from November 1, 2017, to December 15th, 2017. Follow this link to see if you qualify. Your qualification status may vary depending on which region you live in.

How do you sign up for Obamacare?

There are a few different ways to sign up for healthcare coverage in the insurance marketplace. The easiest is to apply online. You can visit to apply. You will have to answer a few questions and should have your social security number and any required government-issued identification on hand.

You can also apply on the phone by calling 1-800-318-2596. This method is helpful because agents will be able to assist you with any questions that you may have. There tend to be some pretty long hold times, so it may be a good idea to call at a time when you will be free for at least 30 minutes without interruption.

You can also apply in person or by mail at a local government office. The location of the mail forms or government office will also vary depending on what state you live in.

What if you don't qualify for Obamacare?

If you don't qualify for Obamacare, and your employer doesn't offer health insurance, you will need to get insurance through a private party insurance company. This means you will want to use the Marketplace. The Marketplace is a government-run system that helps people find health insurance and compare rates and plans.

How do you use the Marketplace?

The Marketplace can be accessed by following this link. It will give you many plans to look at and choose from in your area. They will likely have different premiums, deductibles and coverage limits and options. You can choose the one that works best for you.

What should you look for in health insurance if you are fairly young and essentially healthy?

You will want to take into account what your deductible will be and how to gain access to the coverage that you want for the least amount of money. This means that you will have to way the pros and cons of what you are willing to anticipate versus what you want to pay for.

What is a deductible?

A deductible is the amount you are required to pay out of pocket before the health insurer starts to pay. For example, if you have a $3,000 deductible, you will be required to pay the first $3,000 of any health insurance costs and anything above this amount will be covered by your insurance company. After the deductible is met, you typically will only pay a copay or coinsurance for covered services. Generally, the higher your monthly premium, the lower your deductible.

What is a copayment?

When it comes to healthcare, a copayment is a payment made by a health insurance service recipient that is added to the payments already made by the insurer. It is usually a fixed amount that an individual will have to pay for receiving medical services or prescription drugs in addition to what the insurance company will pay on their behalf.

What is coinsurance?

Coinsurance, similar to a copayment, is a way of sharing costs for health insurance or prescriptions between the insured party and the insurance company. The difference is, that instead of being a fixed fee, coinsurance varies depending on the amount due after a member has reached their deductible.

So what should you look for in healthcare coverage?

A 26-year-old male that's generally healthy, you would want to look for coverage that will cover your basic needs. This will be called a low-coverage plan and will cover you for emergencies, but will cost less. Unless you have a family that will also need coverage or a pre-existing condition that will end up requiring large amounts of medical attention, you're going to want a minimum plan that is inexpensive and will cover your essential health needs. Plans like this will usually include dental, vision, and doctor visits of some sort. You'll end up paying some amount per visit, but ultimately will save the most money in the long run. A good low-coverage option is almost always going to be your best bet. From a financial stance, plans like this have reasonable out-of-pocket maximums and unless the worst case scenario befalls you, you're unlikely to have to pay maximum expenses out of pocket.

What should you avoid?

Avoid choosing a plan that will be more than you need. Keep in mind that just because a plan is more expensive, doesn't mean it will actually serve you better. As a young 26-year-old male, your health is likely pretty good and you don't want to end up paying for services that you will not use. This article can help show you a few other things to watch out for.

Answered December 13, 2017 by LifeHealth

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