What Is Health Insurance?
It is a financial protection that enables a policyholder to meet their treatments, medications, and different services that are allowed by your insurance policy. It might be expensive to spend on health insurance, ‘even if one was not likely to touch any health care service.’ When you do, the insurer is willing to bear half the cost. You can be expected to pay for a deductible, co-payments for fixed amounts or coins for shared cost of service fees.
Certain categories of the plans may entail providers from the network for optimal coverage, others may accept out of network treatment that is often expensive.
ACA Health Plan Enrollment
The open enrollment for the ACA marketplace is from November 1st to January 15th in most states. You can buy or change plans during this period or they can affect your Special enrollment if you go thru changes in your life such as marriage, birth of a child or moving.
Health insurance definition specifies the aspects of a policy that you need to know while choosing right health plan for yourself.
Health insurance usually encompasses a wide range of medical care and could include general practicioner visits, in patient care, outpatient treatments, preventive care, and prescription drugs. Under the Affordable Care Act (ACA), insurance plans in the marketplace must cover essential services like:
Outpatient and emergency care
Hospitalizations
Lab services
Services for mental illness and substance use disorders
Healthcare for women and children including eye and teeth from children.
Prescription drugs
Rehabilitation and habilitative services Currently: The current lack of specific definitions of habilitative services in state laws and regulations has created confusion about coverage for these services for individuals with a mental illness or that development disabilities.
Although, health plans for vision and dental for adults and weight management plans are not mandated, some insurance companies provide them as optional.
Common Exclusions That Health Insurance Does Not Pay For
However not all medical expenses are covered in its totality by the health insurance. Some treatments and services that often aren’t included are:
Various supplementary treatments include acupressure Some CTs and laboratory tests Travel vaccines Dental or vision care (however, an annual check up on the eyes may be allowed) Skeletal and minimal access bariatric surgery and diets
Exclusions vary with the health insurance providing company and policies do not cover all illness and diseases. Common exclusions include:
- Other complementary medicines (for instance, acupuncture).
- Care outside the U.S.
- Cosmetic surgery
- Dental care
- Experimental treatments
- Fertility care
- Hearing aids
- LASIK surgery
- Some prescription drugs
- Diet and exercise and Obesity surgery
It is hereby to note that coverage may differ from one plan to the other. For example, while HMO/EPO may restrict out of network services, PPO may not do so in many instances.
What is the Cost of Health Insurance?
An unsubsidized ACA health insurance averages $635 per month. However, the price also depends on the client’s age to obtain an implant and the chosen metal level. For example:
- As a result, 21-year-olds pay about 425 US dollars per month.
- Average spending on lottery games is $446 among 27 year-olds.
- 30-year-olds pay $483.
- Men and women aged 40 years and below spend about $544.
- 50-year-olds pay about $760.
- The total monthly cost for 60 years old is $1,154.
While it is cheaper to make premium contributions than on Gold plans, the out of pocket expenses on such plans are relatively expensive than on Bronze and Silver plans.
Bronze Plans: Average Monthly Health Insurance Costs
| Company | Age 30 | Age 40 | Age 50 | Age 60 |
| Aetna | $384 | $432 | $604 | $916 |
| Ambetter | $405 | $456 | $637 | $968 |
| Blue Cross Blue Shield | $421 | $474 | $663 | $1,007 |
| Cigna | $441 | $497 | $694 | $1,054 |
| Kaiser Permanente | $357 | $402 | $561 | $853 |
| Molina Healthcare | $441 | $497 | $695 | $1,056 |
| Oscar | $417 | $470 | $657 | $998 |
| UnitedHealthcare | $402 | $453 | $633 | $962 |
Silver Plans: Average Monthly Health Insurance Costs
| Company | Age 30 | Age 40 | Age 50 | Age 60 |
| Aetna | $468 | $526 | $735 | $1,115 |
| Ambetter | $470 | $529 | $739 | $1,123 |
| Blue Cross Blue Shield | $541 | $609 | $851 | $1,293 |
| Cigna | $517 | $582 | $813 | $1,235 |
| Kaiser Permanente | $461 | $519 | $726 | $1,103 |
| Molina Healthcare | $450 | $505 | $706 | $1,069 |
| Oscar | $504 | $567 | $792 | $1,204 |
| UnitedHealthcare | $519 | $585 | $817 | $1,241 |
Gold Plans: Average Monthly Health Insurance Costs
| Company | Age 30 | Age 40 | Age 50 | Age 60 |
| Aetna | $494 | $556 | $778 | $1,179 |
| Ambetter | $505 | $569 | $795 | $1,207 |
| Blue Cross Blue Shield | $588 | $662 | $925 | $1,406 |
| Cigna | $649 | $731 | $1,022 | $1,552 |
| Kaiser Permanente | $483 | $544 | $760 | $1,154 |
| Molina Healthcare | $494 | $555 | $777 | $1,176 |
| Oscar | $529 | $596 | $833 | $1,265 |
| UnitedHealthcare | $550 | $620 | $866 | $1,316 |
Platinum Plans: Average Monthly Health Insurance Costs
| Company | Age 30 | Age 40 | Age 50 | Age 60 |
| Blue Cross Blue Shield | $926 | $1,042 | $1,457 | $2,214 |
| Kaiser Permanente | $544 | $613 | $856 | $1,301 |
Health insurance companies’ complaint history
As noted earlier, when it comes to the number of complaints against the health insurance companies reviewed in this paper, both Aetna and Kaiser Permanente received the lowest scores, which means customers are satisfied with the health insurance companies claims handling, as well as customer relations. This complaint information is gathered by the National Association of Insurance Commissioners from state insurance departments therefore a low complaint ratio can be viewed as an indication of customer satisfaction.
The use Of Technology In health Insurance Companies
In order to measure the companies’ Digital Experience, we looked at their website and smartphone application. These qualities were centered on the aspects of the opportunity to pay the premiums online, administer accounts, and looking for providers. We also looked at how much information available on ACA plans each site offers and the interaction with their social media accounts.
| Company | Digital experience score |
| Blue Cross Blue Shield | Excellent |
| Kaiser Permanente | Excellent |
| Ambetter | Good |
| UnitedHealthcare | Good |
| Cigna | Average |
| Oscar | Average |
| Aetna | Average |
| Molina Healthcare | Poor |
Method of Health Insurance Classification
The types of choices that exist in health insurance plans can be classified with regard to access, cost, and restrictions on referrals. The four most common types include:
Preferred Provider Organization (PPO): PPO is another form of premium service, which allows policyholders to visit providers of their choice, even out of the plan list, but usually for a higher price tag than the plan itself. consult with specialists do not require any referrals.
Health Maintenance Organization (HMO): In general, it is less expensive but is accompanied by stricter conditions. Need a general practitioner referral to a specialist and only approved services from that general practitioner’s network.
Exclusive Provider Organization (EPO): Like HMOs, EPOs no not allow out-of-network service but does not use the referral system when accessing a specialist.
Point of Service (POS): A type of health plan that has elements of both, HMOs and PPOs. Patients select a PCP and require a PCP’s referral to see a specialist but are still able to visit out-of-network doctors for a higher price.
How to Get Health Cover
There are several ways to secure health insurance:
Through an Employer: Health insurance is a common employee benefit where many of them rely on their employer’s plan to get the insurance cover with majority of them paying substandard price since most employers pay for most of the insurance premium.
Through a Spouse: Another option which you may not be aware of is that you are able to get under the spouse health plan which is cheaper than the individual plan.
Through a Parent: In case you’re below 26 then you really don’t need to get a insurance plan of your own, you can remain on your parents’ policy instead.
On the ACA Marketplace: The HealthCare program on ACA enables you to make a comparison of various plans with possibilities of subsidies and the premium tax credits by certain people.
Short-Term Health Insurance: Those who require insurance only for a short time might find that cheap alternative to be the right choice – although it is very limited in its coverage.
Catastrophic Health Insurance: Cool for the young people below 30 years or those who are financially constrained, these plans charge low monthly premiums, and come with high out-of-pocket costs and ACA essentials.
