What Is Health Insurance?
Health insurance is a legal agreement that commits an insurer to covering all or a portion of a person’s medical costs in return for a regular payment. In the case of an emergency, it will save you from becoming bankrupt. Some individuals get health insurance because they are aware that they have persistent medical problems that must be addressed, while others do so out of fear for the unpredictability of the future.
Going without health insurance puts your ability to get treatment at jeopardy, and your financial security is much more at stake. He continues that those who lack insurance (or have inadequate insurance) often put their health at risk by delaying seeking treatment.
Because they are aware of the expense, those who have health insurance are often more willing to see the doctor when necessary. They are more likely to receive required prescription medications because they are more readily accessible and more inexpensive, and they have a tendency to follow up on medical issues that physicians flag, such as high blood pressure, before they become greater problems.
Health Insurance Coverage
All health insurance plans sold on the federal marketplace are compliant with the Affordable Care Act (ACA), meaning they cover a set of 10 categories of services. These essential benefits that must be covered include:
- Outpatient care
- Emergency services
- Hospitalization, such as for surgery and/or overnight stays
- Pregnancy, maternity and newborn care before and after birth
- Mental health care and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices for those with disabilities, injuries or chronic conditions
- Laboratory services
- Preventative and wellness services, including cervical cancer screening and HIV screening and counseling
- Pediatric services, including vision and dental care
Outside these essential benefits, what a plan covers will vary, which is why it’s important to read the fine print.
Cost of Health Insurance
Here’s a look at health insurance cost examples for Bronze, Silver and Gold plans among the large health insurance companies who scored highest in our rankings of the best health insurance companies.
Bronze Plans: Monthly Health Insurance Cost Examples—Large Providers
Silver Plans: Monthly Health Insurance Cost Examples—Large Providers
Gold Plans: Monthly Health Insurance Cost Examples—Large Providers
How to Choose the Best Health Insurance for You
The type of health insurance plan that’s right for you depends on factors such as:
- Your eligibility for a plan
- Costs
- Benefit design
- Provider network
- Prescription drug coverage
If you’re eligible for a health plan through your job or your spouse or parent’s job, that is likely the cheapest way to get comprehensive coverage. If you don’t have that option, you can buy an ACA plan through the marketplace or one of the other options mentioned above.
Here’s how to compare plans to find the best health insurance:
- Look at the costs, including premium, deductible, coinsurance and out-of-pocket maximum. Some plans like HMOs have lower premiums, but they come with more restrictions. On the other hand, a PPO usually costs more but gives you the freedom to get out-of-network care.
- Look at the deductible vs. premium. Someone who doesn’t expect to need much health care may prefer a plan with lower premiums and a high deductible. A person who regularly sees a doctor may do better with higher premiums and lower out-of-pocket costs like deductibles.
- Compare plan type. Dig into the information about the benefit design types and weigh the pros and cons of PPOs, HMOs, EPOs and any other plan offered.
- Check the provider network list to make sure your doctors and preferred facilities are in-network for the plans you’re reviewing. If they’re out-of-network, you may get no coverage for them, depending on the plan.
- If you have prescriptions, check with the insurance company to confirm that they’re covered and see how much you would have to pay out of pocket.
- Does the health plan offer extra benefits such as 24/7 nurse lines and telehealth?
Once you’ve done that work, you can feel more confident choosing the best health insurance plan for you.
Methodology for Company Ratings
Forbes Advisor analysed more than 180 health insurance plans to determine the best health insurance companies. Their ratings are based on:
- Complaints made to state insurance departments (50% of score): We used 2021 complaint data from the National Association of Insurance Commissioners.
- Plan ratings from the National Committee for Quality Assurance (25% of score): The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization that accredits health plans and produces ratings based on specific metrics.
- Plan ratings from the Affordable Care Marketplace (25% of score): We used the federal government’s overall quality rating for the company’s plan(s). Where government ratings weren’t available, a company’s Forbes Advisor rating is based on complaints and its NCQA scores.
Health insurance cost examples are from the federal health insurance marketplace.