Finding the appropriate healthcare plan involves carefully considering your healthcare needs, budget, and preferences. Open enrollment or life events that qualify can enable you to switch plans that better match your goals.
Fidelis Care offers five income-based Essential Plans with no monthly premium, all of which meet the 2024 Income Guidelines tool for eligibility determination. If you believe you may meet these guidelines, use it now to see if one qualifies.
Know Your Options
No matter your insurance needs–individual and family coverage or group plans through work –it is essential that you become informed and make an informed decision when making changes in life, such as having a baby or losing your job. It is especially crucial if these major life changes qualify you to switch up plans like changing to Medicare Part D from an HMO plan or vice versa.
Review all available plans, consider your healthcare needs (how often you visit doctors, etc) and consider your budget, as well as any possible financial assistance programs available to you.
Compare plans by price; those on the Marketplace are organized into “metal” categories of platinum, gold, silver and bronze (catastrophic plans are also offered). Also take a close look at each plan’s network of doctors, hospitals and clinics to ensure it fits your needs – eliminate plans without providers in your area or preferred doctors; additionally those that offer limited provider choices compared to alternatives should be avoided.
The Affordable Care Act (ACA) mandates that most health insurance policies cover essential benefits, such as maternity care, mental health and addiction treatment services and preventive services. Since President Donald Trump’s administration has proposed changes that would weaken these requirements it is crucial to be aware of these proposed amendments and take any necessary steps against their implementation.
Look at Your Budget
If you are self-employed or purchasing health insurance for the first time through the marketplace, it may be daunting to know where to start. To find a plan that meets the unique healthcare requirements of your family and individual members of it. Take time to analyze needs and costs in order to find a plan which suits them all.
Assessing your current coverage involves reviewing what providers, pharmacies and hospitals are included in your network plan, as well as reviewing monthly insurance premiums (or costs) and out-of-pocket expenses. Reviewing options during open enrollment each year or during a Special Enrollment Period when experiencing certain life changes such as marriage, having a child, changing zip codes or losing other coverage are particularly critical steps in making sure your needs are being met properly.
To gain a clearer view of your healthcare expenses, first estimate what was spent last year for both routine and unexpected care, then review your budget to establish how much should be set aside each month in fixed and variable costs – personal finance blogger Logan Allec recommends allocating at least 5% of net income towards these costs – though you could use an online budgeting tool such as Mint or Personal Capital to plan for future expenses such as dental exams or new prescription lenses that you will need to save for.
Explore Your Options
If you need assistance getting started with health insurance coverage and costs, an online marketplace might be an effective starting point. Furthermore, healthcare navigators or counselors can assist in helping navigate through all the intricacies of policies and costs more easily.
Take time to assess your needs and budget when considering health plans, particularly since you can change plans during open enrollment or special enrollment periods (if a major life event such as marriage, having a baby, moving to a different zip code or losing other coverage) takes place. Carefully examine each option; evaluate premium costs, deductible amounts, copayment amounts and out-of-pocket maximums while considering networks such as doctors or pharmacies that you prefer as providers and eliminate plans that don’t include those providers.
Keep in mind that many health insurance plans provide extra benefits beyond what’s required by the ACA, such as telehealth services, gym reimbursement or wellness programs. While these may be great benefits to have, be mindful that they typically come with an increased monthly premium.
If you are considering the Essential Plan, take care to review both its summary of benefits and member contract thoroughly before signing up. You can access both by logging into your Member Portal or visiting Fidelis Care Essential Plan’s website; note that only adults ages 19 or over qualify; each qualifying family member would require their own policy.
Make an Informed Decision
Finding the ideal health plan involves striking a balance between cost and coverage. Factors to keep in mind include your monthly budget, the services covered, whether or not your preferred healthcare providers are included, as well as whether or not our monthly costs calculator could make this process simpler. To assist in making this decision easier for yourself, reviewing a health insurance glossary or using tools such as our monthly costs calculator may prove helpful in simplifying this decision making process.
As part of your decision process, it’s also essential to consider what services you might require in the future. For instance, if your family history includes cancer or another ongoing health condition that needs extensive coverage, purchasing an extended plan might be worthwhile. Furthermore, pregnant mothers or those looking to start families might benefit from purchasing one with maternity coverage and preventive services as part of their coverage package.
The Affordable Care Act (ACA) mandates that individual and small group plans provide at least some essential health benefits (EHBs). This can include services like maternity, mental health care and preventive medicine – without annual or lifetime limits or restrictions. Find out more here about the EHBs!
Fidelis Care offers five income-based tiers of the Essential Plan with $0 premiums for those meeting eligibility requirements, providing comprehensive dental and vision coverage as well as in-network prescription drug coverage – find out if you qualify by entering your income into our 2024 Income Guidelines tool.
