3 Important Things to Know Before Picking Your Health Insurance Plan

The health insurance market can be hard to navigate.  Knowing how to compare plans can be a significant help to you.

New Jersey open enrollment starts November 1st and lasts until December 15th.  If you do not have health insurance, you need to enroll during this time period, if you don’t you will have to wait until next year and you will also get fined due to the ACA rules.

KNOW THE FOUR METAL TIER CATEGORIES

Bronze, Silver, Gold, Platinum.  These categories are all valuable and have different assets that can work for a variety of individuals.  These categories reflect how the costs are shared between you and your insurance plan.  These categories have nothing to do with quality of care.

KNOW YOUR BUDGET AND COSTS OF HEALTH CARE

Budgeting is important when choosing a health plan.  Know exactly how much you’ll pay.  Keep track of your premiums, deductibles, out-of-pocket costs, and other costs. 

Deductible: The amount of loss paid by the policyholder. Either a specified dollar amount, a percentage of the claim amount, or a specified amount of time that must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.

Copayments and coinsurance: P For health insurance, it is a percentage of each claim above the deductible paid by the policyholder. For a 20 percent health insurance coinsurance clause, the policyholder pays for the deductible plus 20 percent of his covered losses. After paying 80 percent of losses up to a specified ceiling, the insurer starts paying 100 percent of losses.

Out-of-pocket maximum: Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

Out-of-pocket costs may be a significant cost to worry about, often times individuals have a lot of out-of-pocket costs to cover.

KNOW THE DIFFERENT TYPES OF PLANS ON THE MARKETPLACE

Depending on the type of plan you choose, the plan may limit you to certain providers.  Ensure that your plan is within your doctor, pharmacy, and other medical providers network.  Some plan options include:

HMO Health Insurance Plans

HMO plans are known to give access to certain doctors and hospitals within their network.  The network is made up of providers that agree to lower their rates for members of their plan and they also meet quality standards. What makes an HMO plan very different than a PPO plan is that care is only covered if you see a provider within the HMO network.

PPO Health Insurance Plans

PPO plans are pretty flexible. They do allow you to choose an in-network doctor at a lower cost or an out-of-network doctor at a higher cost. 
You do not need a referral from your PCP to see a specialist. PPO plans often come with higher premiums.


Cosmo Insurance Agency is a team of health insurance experts who are here to guide you during the open enrollment process in New Jersey. Contact Cosmo to receive a personalized experience.

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