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your health insurance is probably one of
the most important decisions you make on
a yearly basis
unfortunately it's probably also one of
the most confusing
so today let's talk about how to pick
the best health insurance plan for you
on healthcare.gov
[Music]
welcome back my name is sarah and
welcome to health broker's channel
so like i said we're going to be talking
today about how to pick the best plan
but first i gotta say the easiest way to
pick the best plan is to use a broker
and yes i know at ihealthbrokers we are
health insurance brokers but really and
truly
it is the easiest and best way to ensure
that you're getting the right plans
for your budget and for your needs a lot
of people
are under the false impression that if
they contact the insurance company
directly which is the carrier
or go through healthcare.gov that
they're somehow going to get a discount
on their health insurance and that's not
at all true if you're looking at a
specific plan no matter which route you
go to enroll
your monthly premium isn't going to
change there isn't going to be any type
of incentive
yes there are commissions and things
like that that's how agents
of the carrier and brokers get paid but
those are already included in your
monthly premium
so if you have a broker that you trust
that you want to work with
please go that route a broker is a
third-party liaison who works for you
not the insurance company which is the
carrier so they're going to be able to
ask you the right questions to make sure
that your health insurance plan not only
fits your budgets
but it fits your needs if you'd like our
help you can reach us here at eye health
brokers at 888-410-0344
there is absolutely no charge for our
services and that is the case with many
brokers so please
if you're going to go the healthcare.gov
route please use a broker i promise you
it's going to make your life
a lot easier oh while i'm at it please
make sure to like this video
we release these videos on a weekly
basis designed to educate our clients
and our viewers
about health insurance it's a really
important topic that a lot of people
are pretty confused by so we want to
make sure that our viewers and our
clients are making the best decisions
possible when it comes to their health
insurance
so we want to get this information out
there so please make sure to like
this video and of course subscribe
because we do release these videos on a
weekly basis
so today we're going to be talking about
how to pick the best plan for your needs
on healthcare.gov
basically it boils down to two things
which is your budget
and your needs
first let's talk about budget that's the
easiest part to understand
because well you probably have a hard
number in your mind of what you can
afford to allocate for health insurance
so basically you need to take into
consideration your monthly premiums
the deductible co-pays or coinsurance
which is the cost-sharing aspect
and then of course the out-of-pocket
maximum sometimes called out-of-pocket
limits
so let's start with monthly premiums
that's the easiest one to understand
your monthly premium is the amount that
you pay out of pocket
on a monthly basis to keep your
insurance active
it can range quite a bit dependent upon
the plan that you choose and the range
of benefits
the middle tier and of course how many
people you're looking to insure
now your monthly premium is where you
may see a type of
savings reflected if you're eligible for
one of those premium tax credits which
we talk about
plenty in other videos there's four
different tiers that you're going to
choose from you're going to look at
bronze silver gold
and platinum and you may notice that
bronze plans tend to have
lower monthly premiums and as you move
towards platinum you may notice that
those premiums get a bit higher
that's not a hard and fast rule but it
is a pattern that you'll probably
notice then there's your deductible your
deductible is the amount that you have
to meet
out of pocket before your insurance
kicks in so for a lot of these services
basically you're going to have to pay
a hundred percent until you meet that
deductible
and then the cost sharing will begin at
that point you're responsible for
co-pays or coinsurance now you'll
probably notice that with bronze plans
those deductibles tend to be a little
bit higher
and as you move towards the platinum
plans they tend to get a little bit
lower
again not a hard and fast rule just a
pattern that you're probably going to
notice
and there are some exceptions to the
deductible so under the aca the
affordable care act sometimes called
obamacare
there is a list of essential benefits
that all health insurance plans must
offer
now oftentimes these services are
actually offered at
no charge whatsoever even before you've
met your deductible or your out of
pocket max
and even if you haven't met your
deductible many of these services
will be offered with just copay or
coinsurance so you won't be responsible
for the entirety
of the cost it's a very extensive list
it pretty much consists of preventative
services as well as screenings and
diagnostics you know very routine care
so i'm going to put a link to the page
listing all of those essential benefits
as well as a link to the page that
details specifically which ones are at
no charge i'm going to put that
in the description below so that way you
can take a look on your own time
otherwise we'd be here all day with me
listing every single one of those
essential benefits something else to
take into consideration with your
deductible
okay so many plans have just one
deductible where basically your
prescription drug
needs and your medical services are all
going to apply
towards that deductible however some
plans have
two separate deductibles one for
prescription drugs
and one for your health services now if
that's the case then obviously every
time you
purchase prescription drugs then that's
going to go towards your prescription
drug deductible and if you go to the
doctor use medical services that's going
to apply towards your other deductible
you have to meet these separately that
can be a little bit
difficult if you have extensive
prescription drug needs so it's
something to take into consideration
now there's a lot of different variables
and that's why health insurance can be
confusing okay cost sharing now
later in this video we're going to talk
about why this is so important
but let me give you a breakdown on what
cost sharing is
so once you've met your deductible at
this point your insurance
kicks in and they're going to contribute
to a portion of the cost
of covered services and in
network services we're going to talk
more about that later as well
this is how those different metal level
plans are actually delineated
a bronze level plan is going to cover 60
of the costs with you being responsible
for 40
a silver level plan is going to cover 70
with you being responsible for
30. a gold is going to cover 80
with you being responsible for 20 you
see where this is going
and a platinum is going to cover 90 with
you being responsible for 10.
so that's really why very often we see
higher monthly premiums on
platinum plans because the cost sharing
is so much
lower now here's a little bit of a
disclaimer
if when you're applying for your
insurance on healthcare.gov
if you're eligible for not only a
premium tax credit
but extra savings then you're going to
see an asterisk pop
up and it's going to tell you that you
may get these extra savings but
only on silver plans
so if you're eligible for this type of
tax credit plus those extra savings
it'll let you know that you may have
lower monthly premiums
lower deductions and a lower
cost share so as opposed to being
responsible for 30 percent maybe you'd
be responsible
for 20 or 10. it depends upon your plan
so
that's also something very very
important to take into consideration
finally there is out-of-pocket maximums
also known as out-of-pocket limits
these are extremely extremely important
regardless of what health insurance
route
you pursue an out-of-pocket limit or
out-of-pocket maximum is really
important because
basically it can help to save you from
crippling
medical debt which unfortunately a lot
of people that find themselves
in unexpected medical situations dire
medical emergencies they find themselves
with
major medical debt when they don't have
those out-of-pocket limits or
out-of-pocket maximums
so in 2021 under the aca those plans
have a max
of eight thousand five hundred and fifty
for an individual
and seventeen thousand one hundred
dollars for a family basically what this
means is once you've
hit that max or that limit your
insurance is going to cover the rest of
the costs
now i do need to tell you that your
monthly premiums
don't count towards these out-of-pocket
maxes
so as you're paying that monthly premium
on a monthly basis your insurance is not
keeping track of that
what they are keeping track of is your
deductible
and any co-pays and coinsurance that you
pay so your insurance company which is
the carrier is keeping track of that and
once you
hit that out-of-pocket max or
out-of-pocket limit
they're going to take over for 100 of
the costs
however they are not keeping track of
any out-of-network services
that you may be using or benefits or
services
not covered so that is not going to
apply to your out-of-pocket limit
and also even once you've hit that
out-of-pocket limit
if you're utilizing out-of-network
doctors or if you're taking advantage of
benefits
not covered by your specific plan you're
still going to be responsible
for those charges make sense
now when you're looking at different
plans you'll notice that sometimes plans
are going to
offer the max as set by the government
but some plans may offer
lower maxes so that's something else
that you're going to want to take into
consideration
the more difficult aspect to understand
is really what your specific health
needs are
obviously you can't predict the future
budget is much easier to look at
and say this is a hard number this is
what i can afford
and it's very easy to gravitate towards
those plans that seem like they
are going to be less expensive but a
lower monthly premium
may not be less expensive in the long
run so you need to ask yourself a couple
of questions
how often do you and your family visit
the doctor other than the free services
offered by marketplace plans
how often do you make use of those other
essential benefits
do you have any conditions that might
require more frequent visits or in-depth
tests do you have any specialty medical
needs that might require a plan with
more elaborate benefits
and do you have any monthly
prescriptions you'll also need to
understand the plan itself to determine
which plan best suits your needs do you
need the flexibility of a ppo
or can you work with an hmo or epo do
you have a network of doctors and
hospitals that you prefer
do they accept your plan so now you're
probably starting to see that picking an
inexpensive plan may seem like a good
idea
and i'm not saying it's not in all
honesty for a lot of people those bronze
plans or plans with lower monthly
premiums may be great
but it just depends does your plan
accept your doctors and the hospitals
that you use
if it doesn't well then you're going to
have to pay out of pocket for that and
that's going to be a huge waste of money
also does your plan
offer the benefits that you need if you
need additional benefits and those
services are not covered by your
specific plan
regardless of how much you're paying for
it on a monthly basis
well you're going to have to pay for
those benefits out of pocket
and that's going to be an additional
cost so this is why you really need to
have an
honest conversation with yourself about
your budget and your medical needs
this may seem like a lot to take into
consideration and it is
but we're not done yet what about dental
vision or other fringe benefits that you
might need
well you can certainly access those on
healthcare.gov and maybe the plan that
you're interested in
already has them or maybe you want to
add them on
but then you need to compare those costs
with
possibly purchasing a healthcare.gov a
marketplace plan
without those fringe benefits and then
purchasing something like dental from a
private insurance company
very often you'll find that there will
be a cost savings
and you're going to have more choice so
that's
more to take into consideration then
there's even more then we have to look
at plans that offer hsas
so a lot of people are looking to take
advantage of that triple tax benefit
that
hsas which is health savings accounts
offer but those are only offered in
conjunction with high deductible health
plans
and is a high deductible health plan
right for you
we're not going to talk about that
anymore today because that's a whole
long
and extensive topic so make sure to
check out our video that's all about
hsas and high deductible health plans
i'm going to put that
in the description below and then
finally we have to talk about those
premium tax credits so dependent upon
your income range
you may be eligible for a premium tax
credit which can save you
thousands of dollars but what if you're
right on the cusp for becoming eligible
how do you make sure that you can take
advantage of those premium tax credits
that's another video in itself and i'm
gonna put that in the description below
as well
basically like i said before there's so
much information on healthcare.gov and
so many decisions
and so much minutia that it can really
really make your head
spin and then you add into that the
pressure of this extremely important
decision
and it's understandable why so many
people find it overwhelming so again
i say if you have a broker that you
trust please go
with a licensed trusted broker somebody
that can help you
navigate the world of health insurance
to make sure that you're getting the
right plan
for your needs there is no
one-size-fits-all answer
and if you'd like our help you can reach
us here at eye health brokers at
888-410-0344 we're licensed nationwide
with over 200 carriers and there is no
charge for our services
now if you liked this video please make
sure to click like
and subscribe as well to stay up to date
on all things health insurance
and if you have any comments questions
anything any videos you'd like to see
let us know in the comments below and
we'll make sure to get on it
thank you so much and have a great day
bye
you
