Updated Nov. 28, 2022 – During open enrollment season this fall, we want to help you feel informed when selecting an individual health insurance plan that meets your needs and budget, including the potential for financial assistance.
The “shopping” process for individual and family health insurance plans can often feel daunting, but it doesn’t have to be. In addition to selecting a plan that offers quality coverage and meets the needs of you and your family, cost is also a concern for many. Blue Cross and Blue Shield of Kansas has developed tools to help our members (and potential members) evaluate plans and calculate financial assistance.
Today, more than 86% of Kansans enrolled in individual plans through the federal marketplace receive tax credits (also known as subsidies) to reduce the cost of their monthly premium payments.** This subsidy could make purchasing quality health insurance a reality for many by helping to lower their premium cost. Try our health insurance marketplace calculator to see if you qualify for financial assistance.
Some tips we recommend to help you evaluate individual insurance plans, include:
- Consider how much health insurance you and your family will need. If you know you’ll need frequent medical care – or anticipate a major surgery – you may want to explore a gold level plan. If you think you’ll only have routine doctor visits, you may be more interested in a bronze or silver plan that offers lower premiums.
- Balance the budget. Choose a plan that fits your budget and strikes the right balance between monthly payments (your premiums) and the amount you’ll owe when you receive care (the out-of-pocket costs you owe for things like your doctor’s time, labs, imaging, shots, etc.). For example, some plans have higher monthly payments so you’ll have lower costs when you visit the doctor and get your bill. Others have lower monthly payments, but you’ll pay more to your provider when you receive care.
- Check on your doctors. Before selecting an insurance plan, check to see that your doctors and other providers are covered by that plan. Using a doctor not covered by your plan can lead to significant additional costs. In some instances, that can mean there is no insurance coverage at all.
- Know what you are buying. It is important to understand the difference between health insurance and a health benefit plan. At Blue Cross and Blue Shield of Kansas, we offer health insurance that is regulated by the Kansas Insurance Department and guaranteed, meaning you cannot be denied or dropped from coverage regardless of health conditions or the amount of health/medical claims you experience. On the other hand, some carriers issue health benefit plans that can qualify or disqualify individuals for coverage based on past health history, pre-existing conditions, such as diabetes, obesity, skin cancer, and more. Health benefit plans are also not required to cover many of the services that are legally required with health insurance, such as mental health services, chiropractors, maternity stays and more. Health benefit plans may also require waiting periods that must be served before certain benefits are covered. Plus, with a health benefit plan you can be dropped from coverage if you have too many health/medical claims. If you are dropped from a health benefit plan, you may not be able to enroll in a regulated/guaranteed health insurance plan until the annual open enrollment or special, qualifying event enrollment periods, which can leave you uncovered and at risk for major health/medical expenses. If you are unsure if you are purchasing health insurance versus a health benefit plan, be sure to ask if there are any qualifications or screenings you need to complete and what services are required to be covered under the plan.
- Ask for help. You don’t have to do this alone. Insurance providers often provide customer service contacts to help navigate this process.
Finding and selecting a high-quality individual health insurance plan for yourself and your family takes some consideration, but utilizing these tips along with reviewing plan descriptions and checking on financial assistance can help you feel confident in your plan choice.
**Source: Kansas Health Institute