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HOW WELL DO YOU KNOW THE US HEALTHCARE SYSTEM?
We know health insurance in the US can be overwhelming. However, our quiz is easy to understand and will give you some surprising insight into the US healthcare system. Test your knowledge with these important health insurance questions!
2021 Open Enrollment is Near Are you required to have health insurance coverage in 2021? Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by [...]
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Per the Affordable Care Act, all plans must cover the basic 10 essential healthcare services (see minimum requirements for health plans below). However, in addition to these services, carriers may offer additional coverage. The cost of additional coverage will vary depending on level of services covered and who the carrier is. The Affordable Care Act has also mandated that consumers have a choice between four levels of coverage. Accordingly, Platinum covers 90% of your healthcare costs, Gold which covers 80% of your healthcare costs, Silver covers 70% of your healthcare costs and Bronze covers 60% of your healthcare costs.
Accordingly, as you compare monthly premiums, you should also compare copayments, deductibles, and coinsurance.
Copayments – the fixed dollar amount you must pay for a doctor visit or other covered service. Accordingly, for those individuals who visit the doctor frequently, a plan with a low co-pay may be a good choice.
Deductibles – a deductible is the amount you must pay annually before certain healthcare services will be covered. Accordingly, a high deductible, low premium plan is often a good choice for those individuals who are generally healthy.
Coinsurance – after your deductible is met, you will still pay for a portion of your medical services, referred to as coinsurance. For example, many policies pay between 60% to 80% of your healthcare costs, while you cover the remaining 20% to 40%.
You have an annual out-of-pocket maximum that includes copayments, deductibles and coinsurance. Once you reach your out-of-pocket maximum, the insurance company pays 100% of your healthcare costs.
Consider the plan’s healthcare provider network. Whether an HMO or PPO, all health plans have an approved provider network. If you use healthcare service providers outside of the network, there is a good chance those charges won’t be covered by your policy.
No. With the health care reform law, individuals have the right to appeal a health insurance company’s claim denial. The first step in appealing a claim denial is to make an “internal appeal” through your health insurance company. An “internal appeal” is a formal request for your health insurance company to perform a full review of its original decision. Should your health insurance company maintain its claim denial even after the “internal appeal,” the health care reform law allows you to initiate an “external review,” in which you can have an independent third party either confirm or overturn your insurers’ decision.
Is the tax credit (premium subsidy) still available?
Yes. While the government has stopped paying for the cost sharing subsidies of the Affordable Care Act, insurers must continue providing them because the subsidies are required by the Affordable Care Act.
Do I need health insurance to avoid a tax penalty?
No. Under the Affordable Care Act, individuals were originally required to buy health insurance or be subject to a tax “penalty.” However, the Trump administration has recently repealed the Individual Mandate.
While the the Affordable Care Act no longer requires you to have health insurance, it does require carriers to only allow enrollment during an annual open enrollment period. Therefore, individuals can purchase individual insurance coverage on the Individual Market during the annual open enrollment of November 1st through December 15th of each year.
Special Enrollment: You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:
change in legal marital status
a change in the number of dependants
a change in place of residence and the current carrier is not available
significant cost or coverage change a change in coverage of a spouse or dependant