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are you in the market for health
insurance are you unsure about how to
choose the right plan for you and your
family the pennsylvania insurance
department is here to help first let's
talk about when to buy insurance you can
usually only shop for insurance during a
period that occurs once a year called
open enrollment during open enrollment
you can buy a new plan or change the
plan you have open enrollment starts in
October or November and ends in December
or January you can find the dates of the
next open enrollment on healthcare.gov
which is the federal marketplace for
health insurance once open enrollment
ends you can only buy insurance if you
experience a life change like losing
coverage from a job moving getting
married or having a baby if you do not
have insurance you may have to pay a
penalty to the federal government when
you file your taxes the cost of a health
insurance plan can change every year
check if your costs are increasing and
find out if there's a better plan for
you
the Pennsylvania insurance department
reviews changes in plan costs every year
in the spring and summer you can find
out more about this process and comments
on proposed changes on our website so
how do you know what coverage you need
there are three things that you should
think about the doctors a plan works
with this is called the provider network
the prescription drugs a plan covers and
the cost you will have to pay
you will pay less to see providers that
accept your health insurance this is
called in-network
you will pay more to see providers that
do not accept your health insurance this
is called out of network each insurance
company publishes a list of the
providers available in their plan on
their website called a provider
directory now let's talk about
prescription drug coverage if you need a
specific prescription you can check if
that drug is covered under an insurance
plan the list of drugs covered by a plan
is called a formulary next let's talk
about the different costs you will pay
for health insurance the five types of
costs are premiums co-pays deductibles
coinsurance and out-of-pocket limits
your upfront monthly payment for
insurance is called a premium this is
the first price you see but it's not the
only cost you may pay other costs when
you receive care a deductible is the
amount you pay before your insurance
company pays the rest of the cost of
care most plans with low premiums have
high deductibles fees do when you
receive service like visiting the doctor
or picking up a prescription are called
co-pays coinsurance is like a copay it
is a charge due at the time you get care
but as a percentage of the cost instead
of a set fee the out-of-pocket limit is
the maximum amount of non premium costs
that you will have to pay in a year
including deductibles co-pays and
coinsurance the Affordable Care Act made
certain preventive healthcare services
free for anyone with insurance you
should not be charged for these services
to help you decide which combination of
costs and benefits is right for you
insurance companies name their plans by
metal levels the metal levels are bronze
silver gold and platinum
this chart shows how each metal level
represents how you and your plan share
costs Healthcare gov is a great place to
compare plans
it also has information about subsidies
which may lower your premium or
out-of-pocket costs many people who
think they do not qualify for a subsidy
actually do in 2015 a family of four
with an income of $95,000 qualified for
a subsidy you can only get a subsidy
through healthcare.gov which will also
give you information on other programs
if you qualify to help you enroll in
person or over the phone
healthcare.gov has people called
navigators you can also buy a plan
directly through a health plan website
or independent insurance agent do you
have everything you need here's a
checklist make sure the providers and
services you want are covered by the
plan you are considering depending on
how much you use your insurance and the
monthly costs you can afford think about
how you want to balance up front costs
like a premium versus costs you pay at
the time of care like a copay you can
use the metal levels as a guide consider
shopping on the federal marketplace at
healthcare.gov to make sure you don't
pay a penalty always buy insurance
during open enrollment happy shopping
you
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