Personal Benefits

Choosing the right individual health insurance plan is an important decision that should be researched and well thought out. To make a good choice and avoid some common traps, however, you need to keep a few basics in mind, starting with the meaning of such terms as premium, deductible, copay, and coinsurance. Review the checklist we have provided below. Keep in mind your current and likely medical needs and how much you can pay per month as the backdrop. With the right insurance, you could save thousands, perhaps even tens of thousands, if you or a family member gets sick.

If you have any questions, be sure to reach out to a Caribou Insurance representative and we will help you make the best decision.

You must have a “Qualifying Event” or buy during the “Annual Open Enrollment.”

Near the last 2 months of the year you can begin to purchase coverage starting the following January 1st. This period of time to purchase coverage is called the Annual Open Enrollment and it normally ends shortly after January. Once this window passes you can only buy coverage if you have a life changing event, such as the loss of a job, divorce or marriage, and child birth. Other situations may be considered a Qualifying Event, and when they occur you can also change your plan. For example, if you lost your job you could change from a Gold plan to a Bronze plan to keep your costs low while you find work.

You cannot get a tax credit or tax subsidy if you can get coverage through work.

In order to claim this credit when buying your own insurance you and any family members cannot be eligible for coverage through an employer policy. Even if you do not get money from the employer to help with the cost of covering family members they still cannot claim the tax credit or receive the subsidy. You may still purchase your own coverage but it is at the regular price. If you mistakenly claim this credit or subsidy you will have to pay it back when filing the year’s taxes and it can easily reach thousands.

Identify the “must-haves.”

You can’t foresee a sudden injury or illness, but some medical needs can be anticipated. Maternity coverage, for example, is an obvious must-have if you’re starting a family, and not all policies offer it. If you have a family history of heart disease, you may want to make sure your coverage includes the cost of cardiac screening tests and cholesterol-lowering drugs. Under The Affordable Care Act, individual insurance plans must cover the full cost of more than 80 preventive services for men, women & children, including vaccinations and tests for high blood pressure, cholesterol, colon cancer & diabetes, provided by a practitioner in the plan’s network.

Don’t overbuy.

Would you buy a luxury car with a monthly payment as big as your mortgage? There’s not much point in thinking about a luxury insurance policy your budget can’t handle, either. If you’re relatively young and healthy, consider choosing a policy with a reasonable deductible – the amount you must pay out of pocket before certain benefits kick in. A plan with a deductible of $1,000 or more is likely to cost you considerably less per month, and could save you money in the long run. Many plans have the same maximum out of pocket cost for covered claims. Buying the best policy doesn’t always mean you will have the best coverage or lowest overall cost.

Understand the network.

If you have a primary care physician and specialists you like, be sure they’re in the network of any plan you consider buying. Policies generally cover a lower share of the cost of out-of-network care—or none at all. For each plan U.S. News has rated, we supply links to the insurance company’s website. There, you should find a directory of doctors in the company’s network. In addition, remember that all plans have minimum provider requirements and some networks perform better than others. Buying a policy solely on the network, or without considering it at all, can be the single most costly mistake.

Know your share of the costs.

This isn’t crystal-ball gazing. Plans are required to state how much you’ll pay out of pocket, through flat fees called copays & deductibles, and through coinsurance, a form of “cost-sharing” in which you pay a percentage of a medical service. When you’re hurt or sick, seemingly small copays can add up. An expensive procedure could leave you obligated to pay thousands in deductibles and coinsurance.

Make sure your drugs are covered.

You’ll want to make certain that the plan’s formulary, or list of covered medications, includes those you take regularly, especially if they are expensive. Formularies can vary widely between plans, even with the same insurance carrier. Many medications treat the same condition and no insurance company will cover too many options for a single need because they lose the ability to keep costs down.

Look into annual limits on coverage and services.

Thanks to health reform, annual dollar limits on coverage that disappeared entirely in 2014. For most plans today, any individual policy you buy cannot impose a limit on lifetime coverage. But the Affordable Care Act still allows plans to impose limits on services not deemed “essential” and, in some cases, to obtain a waiver allowing them to retain an annual limit.

Factor in your dependents.

If you have children under age 26 without health insurance coverage through an employer, the law permits them to be on your insurance. Policies also can no longer exclude kids under age 19 from coverage because of pre-existing conditions.

Walk through several plans.

It only takes a few minutes to review the main benefits associated with each plan, and some plans that look appealing at first glance may turn out to have cost-sharing features that could burden you with heavy medical costs.