How to Pick the Right Marketplace Insurance Plan: HSA, HDHP vs PPO & More!

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Marketplace Plans are a great option for comprehensive coverage, but there are so many decisions to make:
1. What's the best health insurance for self employed people?
2. HDHP vs PPO
3. HDHP and HSA (Health Savings Account
4. Unemployment and Tax Credits

There are many factors to take into consideration when choosing a health insurance plan but basically it boils down to needs vs budget.

It’s actually much easier to understand our budget because it’s a hard number. There are a few costs you need to take into consideration:
Monthly Premiums
Deductibles
Cost Sharing Expenses (copays and coinsurance)
Out of Pocket Maximums

Your monthly premium is the amount you pay out of pocket to keep your insurance active. If you qualify for a tax credit, this is where you will see those monthly savings. The are four “metal levels” of coverage:
Bronze
Silver
Gold
Platinum

Generally speaking, bronze will have those lowest monthly premiums and platinum will have the highest. If you qualify for a tax credit, it will be applied to your monthly premium regardless of which plan you choose.

Then there is the deductible (the OOP before cost sharing) Under the ACA, all marketplace insurance plans must cover services deemed essential benefits before you meet your deductible. So for these services, you may have a copay or coinsurance as opposed to being responsible for the entirety of the cost even before your deductible is met. Some benefits are also covered at no cost.

Then there is the cost sharing aspect. Once you’ve met your deductible (or before if it is an “essential benefit”) you will pay for a portion of the cost and your insurance will pay for a portion. Even though there may be a pattern in the premiums and deductibles, the cost sharing is how the plans are delineated.

Bronze: 60/40
Silver: 70/30
Gold: 80/20
Platinum: 90/10

Finally, there are out of pocket maximums or limits. This is the max that you will pay out of pocket before your insurance covers 100% of the costs. In 2021, the max for an individual is $8,550 and for a family it’s $17,100. Your plan may offer lower limits and that will be indicated in the plan overview.

You’ll also need to identify your health needs.
1. How often do you and your family visit the doctor?
2. Other than the free services offered by marketplace plans, how often do you make use of the other listed “essential benefits”?
3. Do you have any conditions that require more frequent visits or in depth tests?
4. Do you have any specialty medical needs that might require a plan with more elaborate benefits?
5. Do you have any monthly prescriptions?

You’ll also need to understand the plan itself to determine which plans might best serve your needs:
1. Do you need the flexibility of a PPO? Or can you work with an HMO or EPO?
2. Do you have a network of doctors and hospitals you prefer? Do they accept your plan?

Picking an inexpensive plan may seem like a good idea, but if the doctors and benefits that you need to utilize are not covered by that plan, it won’t do you much good.

Additionally, picking a plan with a lower premium may seem budget friendly, but if you end up having to pay a larger deductible or larger copays for frequent visits, it may not actually be financially advantageous.

That may seem like a lot to take into consideration, but it doesn’t even end there! You'll also need to think about:
1. Additional benefits such as dental and vision. Will you purchase a separate plan?
2. HSAs & HDHPs
3. Premium tax credits

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Marketplace Insurance

HSA & HDHP

Health Insurance 101

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[jeffsouth]

So in other words for the average person health insurance not only doesn't cover much but is too expensive 2 afford

[lawrence]

The whole system is ridiculous but I'm glad you are making these videos. They are helpful

[OffbeatLook]

this video was so helpful, thank you!!

[iovsfzj]

Thanks for the new video! I’m looking forward to seeing what other content you post! Always good to learn as much as you can!

[Int]

Medicare for All! Single Payer Health insurance. It is ridiculous for us to worry about our basic right to health. Thank you for your videos. I appreciate it. We politically solved this problem, we wouldn't have to worry about medical debt and the related consequences i.e suicides, bankruptcy, foreclosure, and so many others.

[gerriepperson]

Thank you for explaining this in a simpler way to understand.

[crtm]

thank you young lady very usefull info.

[carolynwalker]

Thank you so very much for posting this important video.

[HydrogenAgent]

Veterans should get platinum and it should be paid for 100% plus a monthly stipend, a nasty hitting the surface. I'm not talking about benefits because these cards should have extra benefits on them as well. Like free membership to Jim's the coverage of hemp oil with THC.

[vivianhunt]

I understand what you’re saying and thank you for the video. I’m not quite clear about the deductible. So do you pay the deductible before you can even see a doctor or is the healthcare system keeping a calculation on how much your spending and when it reaches the deductible amount then it goes into cost sharing. Also when does the premium kick in? I’m assuming you have to be notified at a later date on how much they’re giving you.

[bobcat]

unfortunately the broker will recommend the plan that pays them the highest commission.

[XanderStoute]

Why can't we simplify taxes and health insurance?

[stevejacobs]

I love health insurance companies, especially when they lower your premium by a mere 7$ but double your deductible the following year. Great system we got in the USA.

[teresaezzell]

I have had United Healthcare this past year and never been contacted as much ever by any other insurance company. I don't have that much healthcare, tho. They set me up in 2012 to die in NC cause they split my bladder in half doing a robotic surgery I never needed, already had a infection showing, before the surgery, told me I had weeks to live, it has been twelve years. It tells me I have no payments. so I like that and they have sent me a card with 175 a month on it for groceries or healthcare items.

[AmericaloAarav]

We are looking to change insurance but we need to know details 😊

[HydrogenAgent]

I want the health care problem that covers my gym cost and my sacred oil. And gives me special discounts because I am a Marine Corps veteran. You know, things like that. Do you understand what i'm talking about

[floralscentkim]

Please explain the first part of your video again. Am I understanding correctly, to purchase insurance we can go directly through an insurance company, directly to Healthcare.gov or through an agent. How is the agent paid when a consumer contacts them? Is it a commission paid by the consumer added to the insurance premium each month or a one time fee paid by consumer or how do I pay the person helping me select a health plan? Thank you so much for your answer in advance and for the great videos.

[LynxStarAuto]

I'm self employed, but file as an S corp, and pay myself via W2. Would I still classify for the typical coverage an employee receives?

[c]

Oscar Insurance plan in Florida is a scam, deliberately delaying service and limiting appointment options

[luz]

What is sep ? Also I just retired and started my social security would that count as part of my income I did report it but was not sure if I completed my application correct.