How To Pick A Health Insurance Plan

Open enrollment for health insurance

Every year, tens of millions of Americans have the opportunity to enroll in a health insurance plan during a specific window of time called the open enrollment period. Consumers can sign up for coverage for the first time or change their existing plan during this period, with coverage kicking in on Jan. 1, 2021. Open enrollment for the 2021 health insurance exchanges, commonly known as the marketplace, runs from Nov. 1 to Dec. 15.

Health insurance exchanges vary by state.

The Affordable Care Act called for the creation of exchanges in each state, but the enactment varies widely by state. There are 15 state-based exchanges, 24 federally facilitated exchanges and six state-partnership exchanges for 2021, according to healthinsurance.Org. The health insurance plans in the marketplace provide subsidies for some lower- and middle-class consumers, depending on their income.

Subsidies are available for people who earn between 100% and 400% of the federal poverty level, according to the U.S. Centers for Medicare and Medicaid Services. For a family of four, that would mean an annual income between $26,200 and $104,800, according to the 2020 Poverty Guidelines published by the U.S. Department of Health and Human Services.

Employer-provided coverage, Medicare and Medicaid

In 2019, about 153 million Americans -- more than half of the non-elderly population in the U.S. -- had employer-provided health insurance, according to the Kaiser Family Foundation. Millions have lost their employer-provided health insurance because of job losses caused by the COVID-19 pandemic.

For people with employer-provided coverage, many companies set aside a two- to three-week enrollment period between October and November, says Rebecca Madsen, chief consumer officer for UnitedHealthcare, a global health insurance company. The company serves individuals, employers and Medicare and Medicaid beneficiaries. For the more than 67 million people who have Medicare, the annual enrollment period runs from Oct. 15 to Dec. 7. Medicare is the government health insurance program that primarily provides health insurance for Americans age 65 and older. It also provides coverage for people with disability status (as determined by the Social Security Administration) and some younger people. Medicaid is a separate federal and state program to provide coverage for people with limited income.

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Which marketplace 'tier' is right for you?

Marketplace health care plans are available in four categories: Platinum, Gold, Silver and Bronze. The tiers are separated based on their cost structure -- specifically, how patients and their plans split the cost of health care, says Corey Ford, director, reimbursement and policy insights for Xcenda, a strategic consulting and field reimbursement services firm that works with pharmaceutical and biotech markets to help them navigate health care markets. "For example, patients who select Bronze plans generally will have lowest monthly premiums but highest out-of-pocket costs," Ford says. "Meanwhile, patients who enroll in a platinum plan will pay the highest monthly premiums but the lowest out-of-pocket costs."

In addition to the four tiers, certain patients meeting certain criteria can also select "Catastrophic" plans, which are affordable options to protect yourself against worst-case scenarios. When evaluating which plan is best for you, consider your medical history, Ford says. If you're relatively healthy and typically have a low number of medical appointments, consider a lower-priced plan, such as a Bronze or Silver option, particularly if you can afford higher out-of-pocket costs. Conversely, patients who are managing a chronic illness -- such as heart disease, diabetes or cancer -- may want to consider a higher-priced plan, typically Platinum or Gold, that offers lower out-of-pocket costs.

Six key elements to consider

When evaluating different health insurance plans, Ford says, it's a good idea to consider these six key elements:

-- The plan's health care provider network.

-- Monthly premiums.

-- Deductibles.

-- Drug formulary.

-- Copayments.

-- Coinsurance.

Consumers should weigh all of these factors, Ford says. "Before selecting a plan, patients should confirm that their preferred health care providers, hospitals and pharmacies fall within the plan's network," he says. "Otherwise, patients may face additional out-of-pocket costs for services at those sites."

When considering a plan, be sure you can afford the monthly premiums. Also, educate yourself on each plan's deductibles -- the amount the consumer must spend before coverage kicks in. Each plan also has a drug formulary, which is a list of prescription medications covered by the plan. "Patients -- particularly those with multiple prescriptions -- should assess coverage of (their) medications by the plan, out-of-pocket costs and any annual restrictions," Ford says. It's also a good idea to learn about each plan's copayments, which is a fixed amount paid when you seek health care, and coinsurance, the percentage you owe on the total cost of a particular service.

Special enrollment period

People who purchase marketplace insurance but miss their state's open enrollment deadline may still have an opportunity to get insurance for the year, Ford says. Those who have experienced certain life events -- such as losing health insurance coverage, moving to another location, getting married, having a baby or adopting a child -- qualify for a special enrollment period. The timing depends on the specific circumstance, but consumers may have as much as 60 days before or after the event to enroll in a plan.

How to avoid paying a tax penalty

Initially, the Affordable Care Act included a penalty for not obtaining health insurance. While you can no longer be penalized for being uninsured on a federal level, some individual states still enforce those mandates, Madsen says. New Jersey, Massachusetts, California, Rhode Island and the District of Columbia impose a penalty for not having health insurance. Penalties vary per state, and are either based on a person's income or are levied at a flat rate.

Consider selecting a plan with telehealth services.

Telehealth visits have become increasingly popular during the COVID-19 pandemic. Virtual visits allow you to connect with a health care provider via a laptop, smartphone or tablet, Madsen says.

Look for wellness incentives.

Many plans now offer financial incentives that reward you for taking healthier actions, such as completing a health survey, improving your fitness by exercising or avoiding nicotine, Madsen says. Some plans offer gym memberships and wellness programs for members at no additional cost.

Health Insurance For COVID-19: Why It's A Must To Have One During The Pandemic

This year, an unprecedented worldwide pandemic has made the entire world sit up and realize that medical exigencies can be tough to handle, especially when we’re not financially prepared for it. With no vaccine in sight and a high infection rate, an increasing amount of people are starting to realize that having a good health insurance plan might be their only weapon against the pandemic.

Despite this, there are still people that don’t have it for two reasons: it’s not cheap, and shopping for one can be strenuous. So where does one go from here?

Why do young people skip health insurance?

Health insurance is a must, especially these days. Photo: Photo by Pixabay (CC0)

In hindsight, it can be easy to see why studies show that many young people don’t have health insurance. On top of the aforementioned fact that it’s not cheap, young people can just easily disregard it because they may feel that they are healthy enough to skip having one. In fact, many of them just go without coverage because they rarely see a doctor. Instead of worrying about insurance premiums and co-payments, you can just pay for medical expenses as you go.

The problem, however, is that these costs can become very large, very quickly, especially in the midst of a global pandemic.

Insurance: a pandemic necessity

One of the things that health insurances usually cover are medical expenses. Photo: Photo by Pixabay (CC0)

In fact, this is exactly what happened, with the health insurance sector gaining a significant increase in people getting policies after the outbreak of the coronavirus. There are even exclusive covers for just COVID-19, in addition to the regular health insurance plans.

Here are other reasons as to why you need health insurance:

1. Because there’s a pandemic  

As mentioned above, getting your health insured right now while the world is undergoing a pandemic that still has no vaccine is critical. Right now, treatments are expensive, and you can easily go bankrupt due to medical expenses. And even if you manage to keep yourself safe until the pandemic (which is what all of us are aiming for), understanding that keeping yourself protected from potential life-changing events like that is one of the best life lessons you’ll ever learn.

2. Because the incidence of lifestyle diseases have increased

With the way the modern lifestyle has evolved, there’s no need to wait until you are past 60 to get insured. Unfortunate as it may sound, but lifestyle diseases are on the rise, and this is prevalent among people that are under the age of 45 years old. Then there are other factors that contribute, such as a more sedentary lifestyle, stress, pollution, unhealthy eating habits, and gadget addiction, among many others.

The likelihood of developing disease at a younger age have increased in the past few years. Photo: Photo by Pixabay (CC0)

Based on studies, these factors may be responsible as to why diseases that are prevalent among the older generation such as diabetes, obesity, heart disease, and respiratory problems are now experienced by younger people too. Getting insurance can take care of this, as a lot of policies cover regular medical tests that can act as precautionary measures by catching these illnesses early, if not outright prevent them altogether.

3. Because buying it early translates to better financial planning  

One of the reasons that many people don’t get health insurance is because it can be a bit pricey at first. However, it’s also important to understand that accidents occur without any warning and how that will work out financially depends on whether you have health insurance or none. In a nutshell, not getting insurance now just sets you up for more financial burdens in the future. Additionally, you also save tax for paying the premium.

4. Because there are now more options for everyone  

Pivot Health provides budget-friendly health insurance that will fit your needs. Photo: pivothealth.Com

Another reason as to why people overlook insurance is because it can be overwhelming to shop for one. Thankfully, there are now services that are focused on making it easier for you, and one of them is Pivot Health.

As a company, Pivot Health focuses on helping you find the right insurance for your needs, which they do so via data and friendly customer service that are then used to create customizable insurance-based products for you and your family.

With a team of financial experts, health insurers, and tech geeks, Pivot Health helps ensure about 72,400 members per month, making sure that their coverage is fit to their own, unique lifestyle and needs.

At the moment, Pivot Health offers Short Term Insurance, Supplemental Insurance, Pre-Medicare, Medicare supplement, Limited Benefit Insurance, and even Dental & Vision. Each of these policies can be customized to further fit your needs, and offer some of the biggest coverage ever at budget-friendly prices.

If you wish to learn more about what Pivot Health can offer, click here.

Signing up for Pivot Health's plans are easy and fast in order to keep you covered as soon as possible. Photo: pivothealth.Com

5. Because buying early means you get the best price and a more comprehensive deal

Buying insurance as early (or as young) as possible essentially increases the chances of you getting the lowest possible premium, as well as the fact that it ensures there is no scope for pre-existing diseases. Any diseases that are diagnosed later will also be covered automatically.

Depending on your coverage, your insurance can also cover more than just hospitalization, helping you pay for other services like day-care or ambulance. Pivot Health, for example, provides telehealth access in all of their plans, as well as dental & vision insurance, as well as insurance loyalty.

Getting insurance while young helps give you peace of mind. Photo: Photo by Pixabay (CC0)

Overall, getting your health and well-being insured is important not just because we are going through a pandemic, but because life can be very unpredictable at times. It is very critical these days moving forward, given that life would probably be different from here on out.

With insurance, you would not have to worry about a medical condition or even a pandemic putting such a strain on your finances. This helps give you peace of mind, which is something that we all need a bit of these days.

Voting Can Be As Good For Your Health As Your Health Care Policy

Health care will be on voters' minds as they cast their ballots in the next two weeks: Nearly 6 in 10 said the issue was "a very big problem," according to the Pew Research Center in June, and the Kaiser Family Foundation found in September that 30 percent of Americans identified either the coronavirus or health care as the most important issue in this election.

There are likely a number of reasons why. More than 30 million Americans under 65 still lack health insurance. Health insurance is expensive, and the costs continue to increase. In 1960, our country spent just 5 percent of GDP on health care; by 2018, we spent 18 percent, meaning that nearly one of every five dollars we spend in this country goes toward health care. That's $11,000 per person per year.

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Each political party has different ideas for addressing these challenges. Democratic nominee Joe Biden wants to expand the Affordable Care Act, while President Donald Trump has promised to replace it.

But there is another good health-related reason to vote: The mere act of voting can help improve your health.

That may sound preposterous; politics are stressful even in normal times — and this year hardly qualifies as normal. Mass protests have swept the nation, millions are out of work and natural disasters from floods to fires have destroyed homes and caused mass evacuations.

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And then there's the ongoing impact of the coronavirus pandemic. Many people are concerned about leaving their homes, much less congregating with hundreds of their fellow Americans at polling places. According to a recent Healthline survey, 68 percent of Americans are afraid they'll get exposed to Covid-19 if they vote in person.

Voting can be done safely during this pandemic: Plan your vote by knowing where to cast your ballot and how much time it will take, where to park and whether you'll need to stand in line. If so, you might want to take a bottle of water and a snack. Wear a mask, keep 6 feet away from others and carry hand sanitizer. If you can vote early or via absentee ballot, do so.

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But vote. It can be a balm for all of today's uncertainty.

A wealth of research confirms that acts of civic engagement such as voting, volunteering and charitable giving deliver significant mental and physical health gains across all age groups.

A Carnegie Mellon University study found that in adults over 50, those who volunteered 200 hours or more in the previous year were less likely to develop high blood pressure and reported greater increases in psychological well being.

Higher levels of civic engagement make the entire population healthier — not just individuals. Researchers at the Harvard School of Public Health created a women's political participation index and found that a one-unit improvement in the index — which included voter registration and turnout — yielded 7.3 fewer deaths per 100,000 women. A UCLA study found that college students with higher levels of civic engagement later reported fewer symptoms of depression.

Voting is particularly beneficial for our mental health. Humans are social creatures, so we naturally want to feel like responsible members of a group, according to Michal Ann Strahilevitz, a professor at St. Mary's College in California.

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"Voting is a form of civic engagement that allows individuals the opportunity to be part of something greater than ourselves," Dr. Timothy J. Legg, a medical advisor to Healthline, told me.

That's why people in households who are told they'll receive public praise for voting are nearly 5 percent more likely to cast a ballot, according to a Fordham University study. The same study found that publishing the names of all eligible, nonregistered voters in the local newspaper also increased turnout.

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Just think about the "I voted" stickers that are ubiquitous on Election Day: Usually, adults find it silly to adorn themselves in stickers, yet millions of Americans are already proudly wearing their stickers this year, thanks to the rise of early voting and absentee balloting. Many are even displaying the icon on their videoconference backgrounds. This little symbol offers public proof that the bearer is a good citizen. (And a sticker shortage in 2018 actually left many Americans feeling pretty upset, according to multiple news reports.)

The positive health effects of voting can extend far beyond Election Day. One study of young people sponsored by the federal Department of Health and Human Services found that those who volunteered or voted were more likely to eat healthy and less likely to experience symptoms of depression years later.

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Voting gives people agency and makes them feel like their choices matter. Consider a Brown University experiment, where participants were assigned to support the fictional "War Party" or "Peace Party." When the election arrived, researchers told some subjects they could vote, and told others that they had scheduling conflicts. When informed of the results of this hypothetical election, those who were told they could "vote" showed higher levels of satisfaction when their party won.

In other words, merely having the ability to vote and influence change can improve our mental health. In a recent Healthline survey, 86 percent of respondents said voting makes them feel good.

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More than 140 million Americans — a record — are expected to cast ballots in this year's election. The stakes are high, and their votes will collectively determine how our nation tackles the rising cost of health care and how we handle access to affordable coverage.

Election Day is rapidly approaching and every eligible American should cast a ballot, whether in-person or by mail. After all, it's not just a civic duty — it's the healthy thing to do.