Family Health Care Plans in North Carolina
Let’s be honest. Shopping for health insurance on the Marketplace established by the Affordable Care Act can feel confusing—even overwhelming at times. One reason is that health insurance plans are complicated; they offer different levels of coverage and out-of-pocket costs as well as different types of networks of hospitals and doctors you can seek covered treatment from. But no matter what complications you face in acquiring and maintaining a health insurance policy, it’s critical that you have coverage. Why?
The future is uncertain. And you need comprehensive coverage to keep from drowning in medical bills due to expensive care. It is also possible that you face a tax penalty should you choose to go without coverage.
Throughout our years of being a consumer advocate, Osborne Insurance Services has helped families find plans that best suit their needs – and, now, satisfies the requirements of the ACA. And with these years and experience comes greater insight about our industry and our clients, which is why we are proud to be an agency that explores all options among leading insurance providers in North Carolina.
The Affordable Care Act, also commonly known as Obamacare, established five “metallic levels” that organize plans into categories based on how much they pay, on average, towards your total cost of medical care:
- Bronze— your plan pays an average of 60%. You pay approximately 40%
- Silver—your plan pays 70% on average. You pay around 30%.
- Gold—your plan pays approximately 80%. You pay around 20%
- Platinum—your plan pays 90% on average. You pay an average of 10%.
Keep in mind that these percentages are only general guidelines. There are several different plan options within each metallic level to choose from. The total or per service amount paid depends on the type of service you use during the year. That’s why it is vital you select the correct plan, and we can fully explain your options and guide you through the process.
Cost Share Reductions
Many consumers who qualify for federal subsidies on the Marketplace may also be eligible for Cost Share Reductions, if they purchase a Silver level plan. If you meet the qualifications, you’ll receive additional funds from the Marketplace, paid to the insurer, that essentially upgrade your policy. There are different levels of the CSR, but your copays, deductible, and out-of-pocket maximum decrease in most cases. The idea is that lower income consumers qualify for better coverage since they have less money to spend on out of pocket costs.
Health Insurance Plans 101: How to Narrow Your Options
We offer a simple six-step solution for families to find and narrow their health insurance options. Here’s what you need to do:
- Identify the coverage you must have. You cannot predict an injury or sudden illness, but you can anticipate certain medical needs. Fertility services, for example, are a feature many families will want as part of their coverage, so it’s important to ensure that the plan has specialist coverage.
- Purchase only what you need. Would you purchase a boat with a monthly payment higher than your home’s mortgage? How about add towing services to your auto insurance policy if you’re a current member of AAA? Determine what you need for your family to enjoy full, comprehensive medical coverage.
- Read about your network. You may have a pediatrician or preferred specialist(s) that you trust, so you’ll want to ensure that this person is part of the network for the plan you select to purchase. You could face higher fees for receiving out-of-network care.
- Be smart. You should know what your costs are: copays, premiums, deductibles. There are fees, both flat and varied, that comprise your out-of-pocket expenses. It’s also important to know whether or not your regular medications are covered as well as the annual limits on coverage and services are for your plan.
- Consider your dependents. Let’s face it, kids tend to use medical services differently than adults. Especially with young children, you can expect more frequent illnesses and trips to the doctor. It’s important to find a plan which takes into account the needs of all family members.
- Review several plans. Look at the details of the plan. Some might seem appealing at first glance, but they’ll quickly sour as you see the exact features and options. A plan that you have not thoroughly reviewed may burden you with expensive medical costs as a result of cost-sharing features. Make sure you are aware of your out-of-pocket maximum, which is the total amount of expenses you can reach in any calendar year before the insurance plan takes over and pays 100% for the remainder of the year.