What You Should Know About Getting Health Insurance

Open Enrollment on NY State of Health is here! If you’re thinking about getting health insurance coverage but find yourself confused about the different types of plans, when you can sign up, and other details, we’ve got the information you need.

November 12, 2018 | HF Healthy Living Team

In New York, NY State of Health is the marketplace designed to help people shop for and enroll in health insurance coverage. Individuals, families, and small businesses can use this marketplace to help them compare insurance options, calculate costs, and select coverage.

You may be looking for a health insurance plan right now, but what kind of plan is right for you? How much will it cost? When should you sign up?

Don’t worry—we’ve got answers. Before choosing your coverage, here’s what you should know about health insurance.

Why Get Health Insurance, Anyway?

Even if you’re in good health, you should still get health insurance. Why? Because even healthy people need the medical and financial protections that health insurance offers.

Health insurance can help you:

  • Maintain or improve your health, or better manage a health condition, by covering regular doctor and specialist visits
  • Get access to free preventive care—like checkups, vaccines, screenings, and other tests
  • Get access to necessary treatment for illnesses or injuries
  • Stay protected from high medical costs, many of which can be unexpected

Essential Health Benefits

What kind of benefits do you get with a health insurance plan, anyway?

The Patient Protection and Affordable Care Act of 2010, sometimes called Obamacare, offers Americans a number of new healthcare rights and protections. For example, under Obamacare, health insurance companies can’t refuse coverage to those with pre-existing health conditions (a condition or conditions that an individual has before enrolling in a health coverage plan).

Under Obamacare, all Qualified Health Plans on an individual state’s health insurance marketplace must cover certain services. These are called essential health benefits, and they include emergency services; prescription drugs; pregnancy, maternity, and newborn care; mental health; preventive services; and more.

See the full list of essential health benefits here.

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Other Important Benefits

Your health insurance plan must cover the essential health benefits you need to stay healthy, but you may be looking for even more. Review your options carefully, as some health plans offer additional benefits such as:

  • Dental – some health plans might cover preventive services like dental checkups; or even more, like oral surgeries and periodontics
  • Vision – some health plans might cover eye exams and other eye screenings; or even more, like eyeglasses or contact lenses
  • Telemedicine – some health plans may offer you access to a doctor—any time of day or night, through video chat or phone—for prescriptions, to get help diagnosing and treating non-emergency conditions, dermatology, and more

Healthcare Costs

Now that you have a better idea of the benefits available to you, you’re ready to pick a health plan. But how much will it cost?

In general, what you pay will depend on your income and number of dependents. If you’re shopping for health insurance on NY State of Health, you may notice that the health plans fall into four categories: Bronze, Silver, Gold, and Platinum. These categories show how you and your health plan share costs; they’re not a rating of the health plan itself or an indication of the quality of care you may receive while covered under the plan.

  • Bronze – lowest monthly premium, but highest costs when you get care
  • Silver – modest monthly premium, modest costs when you get care
  • Gold – higher monthly premium, but lower costs when you get care
  • Platinum – highest monthly premium, but lowest costs when you get care

If you need help understanding certain health insurance words—like premium, copay, deductible, etc.—check out our glossary.

Open Enrollment Periods

Now that you know the different types of health insurance, what they cover, and how much they’ll cost, you’re ready to enroll! But when?

There are certain times during the year when eligible individuals may choose to keep their existing health insurance plan or enroll in a new one. These periods are called Open Enrollment Periods (OEP) or Annual Open Enrollment Periods. This time period varies by plan or program. Some plans allow enrollment all year.

The Open Enrollment Period for Qualified Health Plans on NY State of Health typically runs from November through January each year. You can check the specific dates here.

For coverage beginning January 1, 2019, you must sign up for a health plan no later than December 15, 2018.

The last day to enroll in a 2019 Qualified Health Plan is January 31, 2019. After this date, you can enroll or change plans only if you’ve had a Qualified or Qualifying Life Event (QLE). These events include birth of a child, marriage, loss of employment, loss of coverage, change in place of residence, and more. Learn more about Qualifying Life Events here.

Are you age 65 or older, or do you know someone who is? Do you have questions about Medicare? We’ve got answers to those questions here.

If you live in New York and know you need health insurance for 2019, DON’T DELAY. Visit NY State of Health to learn more now.

 

© 2018 HF Management Services, LLC.

Healthfirst is the brand name used for products and services provided by one or more of the Healthfirst group of affiliated companies.

This health information or program is for educational purposes only and not intended to treat, diagnose, or act as a substitute for medical advice from your provider. Consult your healthcare provider and always follow your healthcare provider’s instructions.

Sources

“The ‘metal’ categories: Bronze, Silver, Gold & Platinum,” Healthcare.gov. Accessed October 31, 2018.
https://www.healthcare.gov/choose-a-plan/plans-categories/

“3 things to know before you pick a health insurance plan,” Healthcare.gov. Accessed October 31, 2018.
https://www.healthcare.gov/choose-a-plan/comparing-plans/

“Health insurance: How it protects you from health and financial risks,” Healthcare.gov. Accessed October 31, 2018.
https://www.healthcare.gov/why-coverage-is-important/coverage-protects-you/

“What Marketplace health insurance plans cover,” Healthcare.gov. Accessed October 31, 2018.
https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

“Dates & deadlines for 2019 health insurance,” Healthcare.gov. Accessed October 31, 2018.
https://www.healthcare.gov/quick-guide/dates-and-deadlines/

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