Heads up, freelancers! The deadline to enroll in a health plan through the Health Insurance Marketplace is THIS SUNDAY -- February 15, to be exact. Procrastinators, crunch time has arrived.
For a long time, one of freelancers’ top concerns was getting health coverage. Now it's easier than ever to shop for a plan, and you can even get help paying your premiums with tax subsidies.
How will you know which plan is right for you? Here are a few tips on what to be aware of when you’re buying health insurance:
Look beyond the premium
There are more costs to consider than just the monthly bill. Depending on your health situation, a plan with a higher premium could be more cost effective when other parts of the plan are taken into account. For example, if you plan on using covered services frequently, a plan with a higher premium but lower out of pocket costs might save you in the long term.
Plan details to look at:
- Copay. A copayment is a set amount that you have to pay for a covered service. For example, you might be responsible for a $50 copay each time you visit your physical therapist. Obviously, if you plan to have 20 visits to your physical therapist this year, you want to look for a plan with a lower copay for physical therapist visits.
- Coinsurance. Coinsurance is the percentage of a bill you have to pay for a covered service. Using the example above, if you’re visiting a physical therapist and your plan has 20% coinsurance for physical therapy, you’d pay 20% of your bill for each visit. In order to understand the actual cost of the visit, call your physical therapy office and ask them to estimate how much a visit costs -- you’d pay 20% of that fee.
- Deductible. The deductible is what you’ll have to pay for health services before your plan will cover anything. So if a plan’s deductible is $3,500, you have to pay $3,500 of your own money before your insurance begins covering costs. Important note: the deductible doesn’t apply to everything. Certain services, like preventative care, are covered from the start and not subject to the deductible.
- Out-of-Pocket Maximum. The out-of-pocket max is the most you’ll have to pay out of your own pocket for health services in a plan year. Once you reach your out-of-pocket max, your health plan has to pay 100% for covered services. On this year’s health exchange, the out-of-pocket max for an individual plan can’t be more than $6,350 for an individual plan and $12,700 for a family plan. Remember, the higher your monthly premium, the lower your out-of-pocket maximum will be, and vice versa.
Remember: Every plan covers preventive care
It’s an ACA mandate that all health insurance plans must cover certain preventive care services 100%. So if you have insurance, you pay $0 for these services:
- Your annual physical
- A yearly mammogram
- Certain cancer screenings
- And more - here’s a full list.
Don’t forget about your prescriptions
Prescription drugs can be pricey, so if you or a family member takes medications, make sure you understand how they’re covered. Find out how your prescriptions are classified (generic, brand formulary, specialty, etc.) because classification means a huge difference in price. Some health insurance plans only cover generic drugs or only cover brand drugs in certain dosages, so if you take a brand drug or a particular dosage, be sure to check out your plan’s “Formulary Drug List” that includes most common drugs or call them for a full drug list.
How big is your health care provider network?
It’s a good idea to find a plan that suits your lifestyle. Are there doctors and hospitals in network near your home? Does the plan you’re looking at offer nationwide coverage or are you only covered in your state? Are your preferred providers considered in-network? These are all great questions to answer while you’re plan shopping.
If you’re in New York, check out our plans through Empire Blue Cross Blue Shield
The plans we offer through Freelancers Union were designed with freelancers’ needs in mind: you can get free unlimited primary care services at the Brooklyn and Manhattan Freelancers Medical offices if you enroll in a Freelancers Medical-eligible plan. As a bonus, they also offer free yoga, acupuncture, and group anxiety coaching.
See if you qualify for a subsidy
You may be eligible for a subsidy in the form of advanced tax credits that lower your monthly premium. To find out if you’re eligible, visit healthcare.gov or call Freelancers Union at 1-800-856-9981. You’ll be asked for your household income and number of dependents so you can compare plans and find the one that meets your budget and wellness needs. You can use this online calculator to find out if you’re eligible for tax credits or subsidies.
You don’t have health insurance. Do you have to buy it?
Yep -- or pay a fee. This year, the fee will be $325 or 2% of your income, whichever amount is higher. It’s also important to note that the fee is per person, not per household, meaning any uninsured dependents will be charged as well. The Tax Policy Center has a helpful online calculator if you want to figure out your total fee.
When is your next chance to sign up?
The current open enrollment period closes on February 15, 2015. After that, you can’t sign up for a plan (except in case of life events such as a birth or loss of coverage) until the next enrollment period, which is scheduled to begin on November 15, 2015. If you’re in New York State, you can still sign up for most health insurance plans through Freelancers Union until February 28, 2015.
Freelancers, make sure you sign up soon! Consider your options before the enrollment deadline so you can go back to focusing on those other, client-related deadlines.