Health insurance is there to protect you and your loved ones when you need it most. Without it, your entire life savings could be wiped out with a single medical bill. Even young, fit, and healthy individuals have to ask themselves: “Is going without health insurance worth the risk?”
With the right health insurance plan by your side, you and your family are fully protected, giving you one less thing to worry about in your darkest hours.
The good news is that understanding the options and available plans means you’re in the best position to save money and get comprehensive coverage! On this page, you’ll find all the information you need to make an informed decision about your 2021 health insurance coverage.
How U.S. Health Insurance Works
Health care in the United States is notoriously expensive. A single visit to the doctor can cost hundreds of dollars, and if a hospital stay is required with specialist care, tens of thousands of dollars can build up in the blink of an eye.
There aren’t many individuals who could afford vast sums of money in the event of sickness or injury, but that’s where health insurance comes in.
In exchange for a monthly premium, a health insurance provider shares the risk and covers a percentage of the expense – reducing your health care costs to a more manageable amount.
Where Can I Receive Care?
Most insurance companies allow enrollees only to visit a specified network of health care providers (doctors, physicians, midwives, nurses, psychologists, etc.). Enrollees who visit an ‘out-of-network’ provider may be required to pay a higher percentage of the cost.
What Does Health Insurance Plan Cover?
The Affordable Care Act standardized health insurance plan coverage. Before the Affordable Care Act, benefits varied drastically from plan to plan. Now, when you shop for health insurance on the Marketplace, all plans are required to offer ten essential benefits:
- Ambulatory patient services (outpatient)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Pediatric services (oral and vision)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices.
Different Types of Health Plans:
Health Maintenance Organization (HMO)
An HMO provides enrollees with coverage through a specific network of healthcare providers. These plans are more affordable, but patients must use specific doctors and specialists to get the costs covered.
Preferred Provider Organization (PPO)
A PPO gives enrollees flexibility to see healthcare providers outside of the network without a referral, but the rates for doing so will be more expensive.
Point-of-Service Plan (POS)
A POS plan is a little of both. It operates like an HMO if you stay within the network, but gives you the option of using out-of-network doctors if you receive a referral.
High-Deductible Health Plan (HDHP)
An HDHP has a higher deductible by typically lower premiums than other plans. This makes it ideal for young and healthy people who are unlikely to need medical care.
Catastrophic plans are available to individuals under 30 years old. The plans have low monthly premiums and prioritize protecting you from high medical bills for catastrophic health events.
What Kind of Health Insurance Products Should you Consider?
Health insurance encompasses several different products. When looking for health insurance, you may have some idea of what you are looking for, such as hospital coverage, dental coverage, etc., but there are so many different products available for you to supplement your basic health coverage.
That is why you want to carefully evaluate your needs and budget to ensure that you get the coverage you truly need.
A medical plan is the foundation of your health insurance, which covers you for any medical care you may require. These plans come with different monthly premiums, out-of-pocket costs, and coverage levels.
Medical plans come in many different forms, including individual, family, and short-term plans.
Evaluating the coverage and the deductible of both individual health insurance plans and health insurance plans for family is essential to ensure that you get an affordable health insurance plan for your needs.
Individual Health Insurance provides medical coverage for only you. Coverage includes everything from a regular checkup to acute emergency care.
When bought through the Health Insurance Marketplace, plans must include the ten essential benefits listed above.
Family Health Insurance has the same benefits as an Individual plan, but coverage is extended to include your spouse and children. Because more beneficiaries are included in the plan, the monthly premium is much higher.
Short-term Health Insurance is temporary coverage often used by Americans outside the enrollment periods, between health plans, or in need of emergency coverage.
Supplemental insurance is designed to cover any gaps your health insurance does not cover.
1) Dental Plans
Taking care of your teeth is essential to your whole body health. Gum disease can be a symptom or sign of underlying medical conditions, which is why you want to be sure that you take care of your teeth. Dental insurance covers prevention, early diagnosis, and treatment, after your deductible. Some will also cover a portion of orthodontia.
Most dental insurance plans have different levels of coverage, depending upon the amount that you want to spend each month. Americans pay between $15-$50 per month depending on location and coverage.
2) Vision Plans
Vision insurance helps cover exam costs, as well as glass or contact expenses, to allow you to keep your eyes as healthy as possible.
3) Prescription Plans
Prescription plans vary widely, depending upon the carrier. From mail-order drug coverage to pharmacy coverage, your prescription plan can save you money on medications you take on a regular basis or those that you take for short term illnesses.
4) Disability Plans
Disability plans provide financial compensation to cover your regular income when you must take off work due to illness or injury.
Short-term disability pays a percentage of your salary for up to 3 months, depending upon your plan. Long-term disability also pays a portion of your salary after your short-term disability ends.
Coverage ranging from $25 per month all the way up to $500. Some of the major disability carriers include Breeze, Ameritas, Assurity and Guardian Life.
5) Life Insurance
A life insurance plan offers some financial security for your family if you were to die. While this isn’t something that anyone wants to consider, it is a fact of life that you need to consider when looking at a health benefits package.
Two types of life insurance are largely available, whole and term life. A whole life policy operates much like a savings account, and when you have paid enough into the account, the interest could pay your premiums. It can be borrowed from as well and will not be canceled unless you request it or pass away.
How Much Will it Cost?
How much your 2021 health insurance plan will cost depends on a range of factors; namely, the country and state in which you live, level of coverage, and your age.
Health insurance plans are separated into four different metal tiers: Bronze, Silver, Gold, and Platinum. The higher the tier, the higher the proportion of medical expenses the plan covers. However, increased coverage, of course, comes with a more expensive monthly premium.
The monthly premium isn’t the only cost you’ll have to contend with. Other health insurance expense terms to familiarize yourself with:
- Out-of-pocket costs: The portion of medical expenses you are responsible for paying when you actually receive health care. Separate from your monthly premium.
- Annual deductible: The deductible is the amount of money you must pay in out-of-pocket costs before the insurer starts to pay their share of costs. If the deductible is $1,000, you would be required to pay the first $1,000 in health care you receive each year, after which the insurance company would start paying its share.
- Copayment: A fixed upfront amount you must pay each time you receive care that is subject to a copay. For example, you might be required to pay a $30 copayment each time you visit the doctor.
- Coinsurance: The percentage of costs you pay once you’ve met your annual deductible. A gold tier plan beneficiary, for example, pays 20% of costs once they have paid their deductible, with the insurer covering the remaining 80%.
- Annual out-of-pocket maximum: The maximum amount of deductible, copays, and coinsurance you are responsible for the year. Once met, the insurance provider will cover 100% of your expenses for the remainder of the year.
How will COVID-19 Impact on Health Insurance Plan 2021
At present, most health insurers are predicting minimal effects from COVID-19 on 2021 health insurance premiums. The vast majority of insurers have declared there will be no rate increase as a result of the disease.
Legally, insurers cannot increase their rates to make up costs the previous year’s costs. Therefore, the rates developed for 2021 must be based on their expected costs for the forthcoming year.
If the pandemic is successfully contained within 2020, insurers will be unable to justify any increase to rates in 2021. However, if the pandemic continues through the rest of the year, insurers might consider COVID-19 will bring them additional costs in 2021.
How COVID-19 progresses in the months leading up to the start of the 2021 open enrollment period on November 1 will dictate what we can expect for 2021 health insurance premiums.