Health Insurance Options & Costs

With the Affordable Care Act, you are now required to obtain at least a basic level of health insurance. Depending on your needs, other plans are available providing greater coverage at a higher price.

The law has changed since it was originally proposed and passed, and will continue to change as it begins to be implemented. This might make it difficult for you to clearly understand what you need and how to get it while trying to find out what’s best and most cost effective for you and your family.
Plans are divided into five categories:
  • Catastrophic: Offers coverage and pays for major medical emergencies; covers under 60 percent of the cost of care given to you.
  • Bronze: Covers 60 percent of the total average costs of care you receive and would have to pay out of pocket.
  • Silver: Covers 70 percent of the total average costs of care you receive and would have to pay out of pocket.
  • Gold: Covers 80 percent of the total average costs of care you receive and would have to pay out of pocket.
  • Platinum: Covers 90 percent of the total average costs of care you receive and would have to pay out of pocket.

How Much Will I have to Pay?

The pricing for your health coverage is customized, based on your income and the number of people in your household. For lower income individuals and families, you may qualify to receive financial assistance from the federal government, known as a subsidy. The federal poverty level determines how much you may receive – it is the minimum amount of income you’re allowed to earn each year on which benefits are calculated. In 2013, the amount for one person was $11,490, but varied up to $45,960 (see chart below). Eligibility for any government benefits, including health insurance, depends on where you and your family fall in relation to the poverty level.

Any assistance for which you may qualify will be paid directly to the insurance company you choose, helping decrease the amount you have to pay for your coverage and the plan you select. It’s simple to understand: those who have the lowest incomes will receive the largest amounts of assistance. Older individuals will also receive a larger credit because their insurance costs are higher.

There is a formula the government uses to calculate whether you might be able to receive a subsidy to lower your insurance premiums. Heavin & Associates can quickly let you know the subsidy for which you may qualify simply by calculating the income you make in relation to the poverty level, and how many members of your family will be included on the plan.

What Are The Benefits?

When you purchase health insurance under the Affordable Care Act, you have many options available to you, and the cost is less than if you obtained insurance somewhere else. You must purchase the basic level of coverage or pay a penalty when you file your 2014 federal income taxes. More coverage can be obtained at a higher cost if you want enhanced coverage and options not offered by the less expensive plans.

Some plans feature a health maintenance organization (HMO) as the basis of their plan – meaning you visit facilities and physicians within their network only after receiving a referral from your primary care physician. Others offer a preferred provider organization (PPO) option where you can go to any facility and physician of your choice without having to get a referral before your visit. There are advantages and disadvantages to either option.

Every person in our country (with a few exceptions) will now be required to have health insurance. The only thing that will differ between you and anyone else is how much you’re paying for your premium; the coverage you’ll receive when you need to see a physician, have an emergency or need medication; and the deductible you’ll need to meet before your plan begins paying for allowable expenses.

Let Heavin & Associates explain the differences, advantages and disadvantages to you in ways that are easy to understand so you can make the best decisions for the care of yourself and your family.

We provide outsourced administration solutions, including annual and ongoing enrollment, Flexible Spending Accounts (FSAs) and Health Reimbursement Accounts (HRAs) administration, COBRA, and Retiree and Direct Billing services.