Buying health insurance: 10 tips for success

Tip #1: Sign up and save

Health insurance offers medical and financial protection in case of a serious illness or accident. In addition to protecting your health, health insurance can help guard against financial hardship, debt, and even bankruptcy.

If you don’t have health insurance through your employer, your spouse, your parents, or another source, you can sign up for private health insurance. In the past, people with preexisting medical conditions were often denied health insurance or charged extremely high premiums. Today, you can purchase private health insurance through the Health Insurance Marketplace regardless of your past or current health.

Signing up for health insurance is the most effective way to plan for a healthy future – for yourself, your family, and your finances.

Tip #2: Don't miss the deadline

Open enrollment is a period when the Health Insurance Marketplace accepts applications for health insurance. Open enrollment takes place every year from Nov. 1 to Jan. 15. 

Tip #3: Choose a health care plan that fits your life

When choosing a health insurance plan, ask yourself:

• What are my family’s most important needs when it comes to health care?
• Who is healthy and who may need more care in the coming year?
• Is anyone planning a surgery or a pregnancy?
• Am I happy with my current plan? If not, what’s missing?
• What did I spend on health insurance last year? Do I expect that amount to change next year?
• How much do I want to spend on health insurance each month?

Discuss the answers to these questions with your family and dependents. Knowing what matters most will help you plan for a healthy future – with a plan that’s built around you.

Tip #4: Change or renew your current plan

Open enrollment is the only time of year to renew or change your current plan (without a qualifying life event). It’s the perfect time to consider what you like about your current health insurance benefits, and what – if anything – you’d like to change.

If your income has changed, someone has changed jobs, you’ve added a new family member, or you’re just not happy with your current plan, now is the time to view all your options and find the perfect health care plan for you. A plan that includes Advocate Health Care will give you convenient access to compassionate caregivers, cutting-edge medical technology, and world-class care that’s built around you.

Happy with your plan and just want to renew? First, make sure your current health insurance plan is still available! If your current plan is no longer available, you can choose a different plan or shop outside the marketplace. But keep in mind that when you buy health insurance outside the marketplace, you won’t be able to take advantage of government subsidies.

No matter which plan you choose or where you buy it, pick a plan that’s designed with you in mind – one that includes Advocate Health Care.

Tip #5: Shop for health insurance only

The Health Insurance Marketplace is for private health insurance only. You can’t get life insurance, long-term care insurance or other types of insurance through the marketplace.

Medicare is another type of insurance that is not offered through the Health Insurance Marketplace. If you’re eligible for Medicare and want to renew or apply for Medicare benefits, you can do so through the Social Security Administration’s website.

But Medicare alone may not be enough to cover your medical expenses. In addition to your Medicare benefits, you can enroll in a supplemental health insurance plan that includes Advocate Health Care so you’re getting the best health care possible.

Tip #6: Go for the Gold (or Bronze, Silver or Platinum plans)

There are four different types of health insurance plans to choose from on the Health Insurance Marketplace. They include:

• Bronze – This plan offers the lowest monthly premiums with the highest out-of-pocket costs for care. Bronze plans are a good choice if you want coverage for catastrophic events like accidents and life-threatening illnesses. Keep in mind that most routine care will need to be paid for out-of-pocket.
• Silver – Silver plans offer a moderate monthly premium and a moderate deductible to match. You’ll pay slightly more per month than you would with a Bronze plan, but you’ll also pay less out-of-pocket.
• Gold – If you can pay a higher monthly premium and want lower out-of-pocket costs for medical care, a Gold plan could be a good choice. Those who expect to make a substantial number of health care visits in the coming year often choose Gold plans.
• Platinum – Platinum plans have the most expensive monthly premiums with the least out-of-pocket expenses. If you require frequent care, a Platinum plan will significantly reduce your out-of-pocket expenses.

Each type of plan provides the same essential health benefits, including hospitalization, emergency care, rehabilitative services, lab tests, prescription drugs, preventive care, maternity and pediatric care, and treatment for mental health disorders and substance abuse.

Many preventive services are 100% covered by insurance – no matter which plan you choose. That means you can get wellness check-ups, regular screening mammograms, screening colonoscopies and more without paying anything out of pocket. And once your out-of-pocket maximum is met for the year, the insurance company must pay for any medical expenses above and beyond that maximum.

The main difference among these four plans is how much your insurance company pays on your behalf, how much your monthly premium costs are and how high your deductible is.

And when you choose a plan that includes Advocate Health Care, you’ll have access to world-class health care at your fingertips – no matter which level of care you choose.

Tip #7: Consider a High-Deductible Plan

High-Deductible Health Plans (HDHPs) are designed to keep monthly premiums low. When you choose a Bronze or Silver plan on the Health Insurance Marketplace, you typically pay a lot less each month than you would for other plans. However, when you do seek care, you'll have to pay more in out-of-pocket costs.

In addition to lower monthly premiums, HDHPs have a higher deductible than traditional health insurance plans. That means there's a minimum amount you must pay out-of-pocket before the insurance kicks in.

How It Works

Once you've met your deductible and your insurance kicks in, the insurance company begins paying coinsurance. 100% coinsurance means the insurance company pays 100% of health care costs once your deductible is met. However, most HDHPs operate on an 80/20 basis – once you've met your deductible, they'll start paying 80% of your costs. You are responsible for the remaining 20%.

You'll continue paying 20% until you've met your out-of-pocket maximum for the year – the maximum amount you'd have to pay for health care in a calendar year. Once that maximum is met, the insurance company begins paying 100% of your health care costs.

Real-World Example

Let's say you chose an HDHP with the following:

• $2,000 deductible
• 80/20 coinsurance
• $4,000 out-of-pocket maximum

On that plan, you would pay a low monthly premium each month. You would also pay higher out-of-pocket fees for doctor appointments, urgent care visits, lab tests, and other nonpreventive types of care.

The amount you'd pay for each health care visit would accumulate until it reached your $2,000 deductible. At that point, the insurance company would begin paying 80% of your health care costs. You'd then be responsible for 20% of those costs until you reach your maximum out-of-pocket of $4,000.

• For a $3,000 doctor's bill, you'd pay $2,200 total: $2,000 to meet your deductible, then 20% of the remaining $1,000 that's due, or $200.
• For a $12,000 doctor's bill, you'd pay $4,000 total: $2,000 to meet your deductible, then 20% of the remaining $10,000 that's due, or $2,000.
• For a $200,000 doctor's bill, you'd still only pay $4,000 because that's your out-of-pocket maximum for the year.

As you can see, the monthly premium and deductible are not the only costs associated with an HDHP. You also have to consider the initial out-of-pocket costs, the coinsurance (how much the insurance company pays once your deductible is met), and the out-of-pocket maximum (the maximum amount you'd have to pay in a given year).

A high-deductible health plan could be right for you if you're generally healthy, don't anticipate any major upcoming health care costs, and aren't planning any major surgeries.

If you’re considering one of these plans, you should also consider setting aside money in an emergency fund or a health savings account (HSA) to help you pay for out-of-pocket costs.

Ready to choose an HDHP? Choose one that includes Advocate Health Care.

Tip #8: See if you qualify

If you can’t afford to buy private health insurance on the Healthcare Marketplace, you may qualify for tax credits or subsidies to help offset the costs of insurance.

The size of your family and your household income determine whether or not you qualify for tax credits which can be used to reduce the cost of monthly health insurance premiums, or be issued as a refund on your tax return.

In addition to tax credits, you may qualify for a reduced-cost health insurance plan based on your income, or for your state’s Medicaid program. See if you qualify here.

If you’re having trouble finding affordable insurance or think you can’t afford medical care, we’re here to help. View our financial assistance options to find out more.

Tip #9: Choose the right network

In-network is the term used to describe a group of health care providers that your insurance company has agreements with. When you seek in-network care, your insurance usually covers more of your fees and your overall health care costs are lower.

If you choose to go to a doctor or hospital that is out-of-network, you're more likely to pay higher out-of-pocket fees than you would if you'd stayed in-network. So staying in-network – and choosing the right network – is important.

When you choose a health insurance plan that includes Advocate Health Care, you’ll have access to:

• Some of the top hospitals in the U.S.
• Doctors and providers known for medical excellence and innovation
• Top-rated clinics and specialty programs
• Nearly 400 sites of care and 12 hospitals throughout the Chicago area
• Evening, weekend and online appointment options to fit your lifestyle

Tip #10: Give yourself the best health care

When you choose the right health insurance plan and the right network, you’ll get access to a high-quality health system – not to mention the best doctors, best hospitals and best care options available.

When looking for a great health care system, you should:

• Look at customer ratings. What are others saying about the quality of care they’ve received?
• Look for clinical excellence and medical innovation. Advocate has received multiple national and regional awards for cutting-edge care.
• Look for convenience. Our nearly 400 sites of care and 12 hospitals are close to your home, work or school.

Plan for a healthy future with a plan that’s built around you.

Call 877-732-6334 to speak with one of our Enrollment Assisters or enroll now.