The best healthcare policy is the policy that fits your health, lifestyle, habits, and budget, taking into consideration yourself and your entire family. Finding this balance takes some research, or requires some guidance from your independent insurance advisor.

You’re reading this because you’re probably uncertain about how healthcare insurance works especially with the nationwide changes surrounding The Affordable Care Act (aka Obamacare). With all the different information available out there, it’s difficult to navigate between all the options and mandates. So we wanted to help you answer this question for yourself: “How do I know I’m getting the best healthcare policy for me?”

As a rule of thumb, here are steps to follow, in the order of priority, so you can determine what “best policy” means for you:

1. Determine your health and lifestyle habits.
   1. What kind of medical attention will you and your family need? (What kinds of doctors will you need? How often will you need to access medical care?)
2. Determine the type of plan that will cover your needs. (HMO, PPO, POS,) For example, if you have a specific doctor, you can find out which network of providers they are a part of.
3. Determine how you will pay (i.e. which metal tier to choose), and if you can save (premium tax credits).

But to help you follow these steps, we have to back up and cover some basics.

Health Insurance Basics

Everyone is required to have health insurance

First, every US Citizen under 65 is required by law to have health insurance. This is a mandate. For the year 2016 the penalty for not having qualifying health plan resulted in a fine of $695 per adult and $347.50 per child, or 2.5% of your total household income -whichever was higher. It doesn’t matter where you purchase your health insurance, the requirement is that you are enrolled in qualified coverage.

There are different enrollment options for health insurance:

1. Through your employer sponsored health insurance where your employer pays part of your monthly premium.
2. Through direct purchase
3. Through “The Marketplace” – a term you see and hear all the time to refer to the government regulated health insurance marketplace that subsidizes your monthly premium that accounts for your income.

Different types of networks and quality of care

You’ve heard of these networks before: PPO, HMO, and POS. They all deal with the provider network and what each plan is contracted to provide you. It’s important to know what type of health care you’ll need because certain plans, like an HMO, may require a referral for any type of specialist care that you need. Or certain hospitals or doctors may not be in network with a PPO. Determining your health needs is the first essential step, then isolating the provider network that serves your needs is the step that should follow. This step is associated with identifying the quality of care you expect to receive.

How much insurance pays and how you save on healthcare costs

There are 4 tiers that differentiate how you pay for healthcare. The metal categories is standard throughout all insurance providers within and outside The Marketplace. There is Bronze, Silver, Gold and Platinum. These tiers basically divide up what you pay out-of-pocket and what your insurance will pay. It works similarly to other types of insurance. The lower you pay on your monthly premium, the less your insurance covers, and the more you pay for the actual cost of care. Bronze typically has the lowest monthly premium, and is usually ideal for those who are healthy, safe, and budget conscious. You can click the link to see how the metal tiers are divided.

Depending on your income, there’s a chance you could be saving on your healthcare costs, either through a subsidized monthly plan (Advanced Premium Tax Credit), or through a year-end tax credit. Your savings benefits are calculated based on your household income and size. If your employer does not contribute to a health insurance plan as part of your employee benefits, your first step would be to see if you are eligible for savings. No matter where you enroll, whether through The Marketplace, directly with the insurance provider, or through your insurance agent, you will pay the same price for your plan. That’s an ACA mandate to insurance carriers.

Health insurance in Illinois

Insurance providers who sell in The Marketplace are all guaranteed to include coverage for

• Preventative Care
• Checkups
• Having a Baby
• Prescription Medicine
• Emergency Care

There are several insurance carriers that sell in The Marketplace and it will differ by your location, as some are not available in all areas, these companies include:

• Celtic Insurance Co. (Ambetter)
• Health Alliance Medical Plans, Inc.
• Health Care Service Corporation, (Blue Cross Blue Shield)
• Humana Health Plan, Inc.
• Cigna

Finding a balance between your priorities is what determines whether or not you have the best healthcare policy. We’ve outlined the providers within the state of Illinois who sell through The Marketplace, so you can be certain whether or not you’re saving as much as you’re able to save.

You can also reach an insurance advisor if you have further uncertainties. They’re able compute a sure quote that will help you decide the health insurance policy that’s best for you.