Individual and Family Insurance

What to consider when choosing Individual and/or Family Health Insurance

There are several important aspects to consider when shopping for Individual Health Insurance: affordability, hospital and doctor availability, and plan benefits.

What can you afford?

Depending on your family size and income, you may qualify for a Premium Tax Credit to reduce your premiums, as well as Cost Sharing to lower deductibles and copays. It is important to know your out of pocket costs to control the cost of your plan. Costs include: the deductible, copays for doctor visits and prescription medications, and the out of pocket maximum. An HSA may be paired with a high deductible health plan to receive a tax advantage when paying qualified medical expenses

Metallic Levels

According to the Affordable Care Act, plans are broken into five metallic levels, and each plan pays different amounts of the total costs of the average person's care. Determining the level best for you will depend on your overall healthcare needs for the year.

  1. Bronze – Your health plan pays 60% on average. You pay about 40%.
  2. Silver – Your health plan pays 70% on average. You pay about 30% (eligible for additional cost sharing based on income).
  3. Gold – Your health plan pays 80% on average. You pay about 20%.
  4. Platinum – Your health plan pays 90% on average. You pay 10%.
  5. Catastrophic – Pay less than 60% on average. This plan is available to people under 30 years old, or have a hardship exemption. (Not eligible for Premium Tax Credits)

Doctors / Hospitals

Choosing an (In-Network) provider that your plan accepts is a great benefit to you. If you choose an in-network provider, out of pocket costs are less than going to an out-of-network provider. In some cases, going to an out-of-network provider will leave you responsible for the entire cost of your care.

Most Common Network Based Plans

PPO (Preferred Providers Organization) are plans that have both in and out of network coverages. While using providers in the insurance company's network, your costs will be lower. You are still able to see providers outside the network but you may pay a larger portion of the charges.

HMO (Health Maintenance Organization) are plans that only cover providers in the network, except in an Emergency or Urgent Care situation. If the provider you choose does not have an agreement with the insurance company, services will not be covered. Most HMO's require a referral from your primary care provider to see a specialist that is within the network. The HMO's often provide integrated care and focus on prevention and wellness.

Navigating through the different plan options is overwhelming. As an independent health insurance agency, we are able to assist you with this complicated process. We will help you determine the plan that is going to best suit the needs of you and/or your family. Contact us today at (920) 831-3210 to set up a one-on-one appointment with one of our Licensed and Certified Health Insurance Consultants.

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Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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