With open-enrollment dates for your health insurance plan fast approaching, we prepared some useful information and a list of health insurance companies to make the process easier for you.
We made a short overview of the main trends and issues to be aware of when it comes to the American healthcare system, which changes frequently. We navigate through the complexity of how health plans and marketplaces function, and we have marked some important dates and deadlines for you. The main focus is on health insurance companies and their ratings, along with how to get a cheap healthcare plan.
Healthcare in the U.S.
We won’t lie to you – the process of understanding how to take care of your health is complex — often aggravating. Besides grasping how the overall system functions, you should take into consideration factors such as your zip code, age, sex, whether you smoke, income, life situations, etc. Let us steer you through some important facts and numbers.
Background and Context
The discussion about changing the healthcare system in the United States has been going on for many decades. The most significant reform occurred in 2010, when the Affordable Care Act, or ACA (also known as Obamacare), was enacted. The main goal of the law was to reach out to individuals and families who otherwise couldn’t afford to carry medical insurance. The bill aimed at increasing the range of people eligible to be insured under programs supported by the federal government such as Medicare and Medicaid.
Statistics show that between 2013 and 2017, there was almost a 5-percent increase in the number of people who have health insurance in the United States. Nearly half of that rise is due to a significant increase in the number of Medicare users — people qualify once they turn 65 years old. The latter reflects the demographics of American society and population aging trends.
There is notable growth in the size of healthcare costs, as they now represent 17.8 percent of the GDP. Expenditures are rising significantly faster than income, and the prices of goods and services. The percentage of a single-household income that is spent on private healthcare has doubled since 2000. The out-of-pocket expenses on healthcare are responsible for the most considerable portion of spending within a family budget. Moreover, we have to pay higher insurance monthly premiums and deductibles, while our salaries fail to meet the growing pace. On average, the premiums for family coverage per year amount to almost $20,000, and that figure is expected to rise in the 20 years to come.
Despite the enormous number of health insurance companies that operate in the American market, consumers have less choice than they did in 2014. The reasons include different economic drivers and mergers in recent years. The result is that in [year], the citizens of Alaska, Delaware, Mississippi, Nebraska, and Wyoming have only one company to turn to for a health plan. This is still better than in 2018; last year, Iowa, Oklahoma, and South Carolina were also on that list.
In [year], only in the states of California, Nebraska, and Wyoming can you could choose between more than ten health insurance companies. The situation throughout the country is even more complicated — if some company operates in a particular state, it doesn’t mean that it covers the whole area. Citizens in rural areas often do not have any choice in the company they can sign their insurance policies with. If you want to learn more (and you are into maps, charts, and infographics), explore the Insurance Participation on ACA Marketplaces, 2014-2019.
What Does the Future Hold?
Policymakers have been trying to reform the healthcare system through diverse initiatives. One of the proposals is to introduce universal coverage in American society — an act that ideally will guarantee health insurance for all citizens. The U.S. is one of the few countries in the developed world that doesn’t provide that for its citizens. The discussion about Medicare for All has been intense, while voters have proven their interest in the topic. Meanwhile, North Carolina is working on changing the existing fee-for-service model to one concentrated on health outcomes. Otherwise, said insurers would be financially encouraging prevention and keeping patients’ health indicators in check.
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Health Insurance for 2021
No matter what is on the discussion board, you will have to look for a health plan for the next year very soon. If you haven’t checked the healthcare.gov website yet, we prepared some useful information to consider.
Open enrollment for America’s health insurance plans starts on December 1st and ends on December 15th. The coverage period is from October 1, 2021. What you need to know is that if you don’t sign for your health plan within that period, you can’t obtain insurance for 2021. However, several circumstances might allow you to qualify even if you miss the deadline.
Special Enrollment Period
Certain life events will make you eligible to enroll in a health plan, even if it is outside of the open enrollment period. Losing health coverage is one such circumstance. Changes in your lifestyle can also qualify you for a Special Enrollment Period. That will be in case you are moving to a new place, getting married or divorced, having a baby, or adopting a child. No matter the date, if you fulfill specific criteria, you might be eligible to apply.
Medicaid and the Children’s Health Insurance Program (CHIP)
These two programs guarantee affordable medical coverage for people with low income, families with children, pregnant women, and other vulnerable groups. Enrolling in one of the programs can happen over the whole year, so there’s no need to worry if you missed the deadline. HealthCare.gov advises citizens to apply, even if they don’t qualify based on income only. Some states have expanded the programs to cover a more extensive group besides the most vulnerable, so factors such as children, pregnancy, and disabilities might weigh in.
What if I Miss the Deadline?
If you didn’t get the chance to sign in the open enrollment period, you might consider short-term health plans. Since the removal of the individual mandate, they have become popular again. Short-term health plans are cheap options that unfortunately do not offer much in coverage. If you have pre-existing conditions or you want to get preventive care, they won’t be the best option for you. However, if you are young and healthy, that might be the right solution. Keep in mind that you can’t obtain a short-term health insurance plan through the marketplace. Health insurance is an essential part of everyone’s personal budget, so it is recommended to make your decision on medical coverage by December 15.
Where Can I Buy Health Insurance?
The Health Insurance Marketplace, also known as the Exchange, is a service that provides people the opportunity to shop for their health insurance. Applying through the marketplace allows you to find out if you are eligible for some premium tax credits and more affordable medical coverage. HealthCare.gov is the federally run marketplace that operates in most states. However, some states run their Marketplaces.
Below is the list of states that have their own enrollment websites:
- District of Columbia
- New York
- Rhode Island
What to Look for When Selecting Your Health Plan
Premiums, deductibles, co-insurance, co-payments, and out-of-pocket expenses are some of the factors that influence how much you would end up paying for your health and well-being per year. So, how does medical coverage work? Before shopping for a plan, we recommend you to get familiar with this glossary of medical and health insurance terms.
This is the amount you or your employer is paying for the health insurance plan. It is paid annually, quarterly, monthly, or biweekly as a paycheck deduction. For example, if you live in North Carolina, the average monthly premiums (with no premium tax credit) per month are as follows:
- Bronze plan – $413
- Silver plan – $582
- Gold plan – $606
This is the amount of money you are to pay for using health care services before your medical insurance starts covering the expenses. If your deductible is $2,000, your insurance is not paying any medical services until you have met the out-of-pocket $2,000 deductible for covered healthcare bills.
This is the percentage of the covered medical service expenses that you are to pay. If you have already reached your deductible and you go to the doctor, and your co-insurance is 20 percent, a $50 visit means that you would have to pay $10. That’s 20 percent of the total cost.
It is a fixed amount you pay for certain health services (i.e., $10 for an office visit or $20 to see a specialist). It is to be paid upon receiving service.
The limit of healthcare costs that you will have to cover during the period of your insurance policy. After you have reached this amount, your plan will pay 100 percent of covered healthcare services. Premiums are not included in this limit, as well as paying above the eligible costs to cover for a more expensive service. Be aware that some plans don’t calculate all of your co-payments, co-insurance, and deductibles towards this limit.
Essential Health Benefits
The Affordable Care Act foresees ten categories of essential health services that every medical insurance plan has to cover. Dental insurance for children is also to be included, while dental services for adults could be an option. Service requirements vary from state to state, and some plans offer more assistance than others.
Health plans cover visits to the doctor, hospital care, prescription drugs, pregnancy, laboratory work, rehabilitation services, preventive and wellness, etc. However, infertility treatment doesn’t fall within the list of essential health benefits. Under the mental health parity law, medical benefits also cover expenses for counseling, psychotherapy, substance use disorder services, etc. Despite the parity law, there has been proof that insurance companies do not comply with the requirements and refuse to pay for mental health services. Pre-existing conditions do not influence the size of the premiums. They are not a reason for health insurance denial under the ACA.
Rating Health Plans
One of the easiest ways to get a handle on the variety of companies and health plans is to look at ratings. This is helpful when you are looking for affordable health insurance companies. The National Committee for Quality Assurance (NCQA) has developed Health Insurance Plan Ratings. The list includes private, Medicaid, and Medicare plans. The score is given by assessing clinical quality, customer satisfaction, and the results of the NCQA Accreditation study. The emphasis is on the outcomes of healthcare and feedback from plan members.
When browsing through the ratings, you can select by plan type or state. It makes it easier to find out which is the highest-ranked plan in your area. Look for scores above 4. Currently, the ratings show the results from last year. However, the new [year] ratings will be released on December 20th.
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Customer Satisfaction Levels
For the 13th-consecutive year, J.D. Power performed a survey to investigate the levels of health plan members’ satisfaction with the medical benefits they have signed for. The study measures peoples’ contentment within 146 health plans and covers an area of 22 regions in the United States. Nearly 29,000 commercial health plan members took part in the survey, which was conducted from February to March of 2020.
The primary outcomes from the [year] analysis show that satisfaction levels are kept similar to the ones from the previous year. However, plan members are critical to the health insurance services they receive compared to customer experience in any other economic field (i.e., real estate). Insurance companies perform well in managing the plans and their businesses. They fail, though, at providing enough guidance and support to their clients when it comes to expenses and coordination of medical care. High co-pays for doctors’ visits is a primary source of disappointment.
The highest level of customer contentment is scored within the following six regions: Maryland, California, East South Central, Michigan, Illinois/Indiana, and Virginia.
Leading Health Plans Per Region
Here is the list of health plans that scored highest based on plan members’ feedback in the [year] survey results. It might help with your choice of a health insurance company. However, do your research — some plans and companies might score high in one state but have a low rating in your area.
California: Kaiser Foundation Health Plan, California Average, BlueShield of California
Colorado: Kaiser Foundation Health Plan, Cigna, Colorado Average
Delaware/West Virginia/Washington, D.C.: Aetna, Highmark, BlueCross BlueShield Delaware
East South Central: Cigna, BlueCross, and BlueShield of Alabama, Humana
Florida: AvMed, Humana, Cigna
Heartland: BlueCross BlueShield of Oklahoma, BlueCross BlueShield of Kansas City, BlueCross BlueShield of Kansas
Illinois/Indiana: Health Alliance Medical Plans, BlueCross BlueShield of Illinois, Illinois-Indiana Average
Maryland: Kaiser Foundation Health Plan, Cigna, Maryland Average
Massachusetts: BlueCross BlueShield of Massachusetts, Tufts Associated Health Plans, Massachusetts Average
Michigan: Health Alliance Plan of Michigan, BlueCross BlueShield of Michigan, Michigan Average
Minnesota/Wisconsin: HealthPartners, Dean Health Plan, Anthem, BlueCross BlueShield of Wisconsin
Mountain: SelectHealth, Regions BlueCross BlueShield of Utah, Mountain Average
New Jersey: Cigna, UnitedHealthCare, Horizon, BlueCross BlueShield
New York: Capital District Physicians Health Plan, MVP Health Care, Independent Health Association
Northeast: Anthem, BlueCross BlueShield of Connecticut, Aetna, Cigna
Northwest: Kaiser Foundation Health Plan, Premera, BlueCross, Providence Health Plan
Ohio: Aetna, Medical Mutual of Ohio, UnitedHealthcare
Pennsylvania: Capital BlueCross, UPMC Health Plan, Highmark BlueCross BlueShield
South Atlantic: Kaiser Foundation Health Plan, Humana, Aetna
Southwest: BlueCross BlueShield of New Mexico, BlueCross BlueShield of Arizona, Cigna
Texas: BlueCross BlueShield of Texas, Cigna, Texas Average
Virginia: Aetna, Anthem Health Plans of Virginia, Virginia Average
Overview of Health Insurance Providers
Obviously, from the list above, some companies offer plans that people are quite satisfied with. Another critical factor is the size of a provider. When it comes to health insurance companies, the number of members is crucial. Here are the top eight insurers in numbers of enrollees, according to Forbes Magazine.
- UnitedHealth Group – 49.5 million health plan enrollees, $201 billion revenue
- Anthem – 40.2 million health plan enrollees, $90 billion revenue
- Aetna – 22.2 million health plan enrollees, $60.6 billion revenue
- Cigna – 15.9 million health plan enrollees, $41.6 billion revenue
- Humana – 14 million health plan enrollees, $53.7 billion revenue
- Centene – 12.2 million health plan enrollees, $48.3 billion revenue
- Molina Healthcare – 4.4 million health plan enrollees, $18.8 billion revenue
- WellCare Health Plans – 4.37 million health plan enrollees, $16.9 billion revenue
Here are a bit more information and specific features for the outstanding health insurance companies out there. The insurance providers are listed in alphabetical order.
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The company was founded in 1853. In 2018, it was acquired by CVS. Aetna is among the most affordable health insurance companies on the market. It provides plans under the Affordable Care Act; however, short-term health plans aren’t offered. The company is focused on working with businesses to provide employees with medical benefits, so it is a perfect choice for small employers. It provides coverage in all 50 states and has an extensive network of doctors and hospitals to choose from, so the limited offer of HMO types of plans is not such a challenge.
Anthem is the second-most significant health insurance company in the U.S., based on its members. It operates in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. In each state, the company functions under a different name and offers specific insurance products. Most of the Anthem insurance companies are licensed to offer Blue Cross Blue Shield health plans. They work with businesses and operate on Medicare and Medicaid markets. The Anthem plans include PPOs, HMOs, POS, and other hybrid plans, depending on the company’s location. Besides health insurance plans, the provider has additional products on their portfolio — vision insurance, dental insurance, life insurance, and travel medical insurance. For employers, they offer group medical benefits plans and employee health and wellness programs.
BlueCross BlueShield (BCBS)
Blue Cross Blue Shield is a national association of 36 BCBS companies. It has been operating since 1929. Because each provider works independently, there is a wide variety of insurance products and plans to choose from — both HMO and PPO. BCBS operates in all 50 states. Moreover, they provide medical coverage in over 170 countries around the world. The company is proud of its personalized approach to their members and offer a good choice of in-network providers.
With a rich history of more than a hundred years, Cigna is a global player. It formed as we know it in 1982 through the merger of INA Corporation and Connecticut General Corporation. It operates in Arizona, California, Colorado, Connecticut, Florida, Georgia, Maryland, Missouri, North Carolina, South Carolina, Tennessee, and Texas. A network of more than 500,000 physicians guarantees a diverse choice of doctors and hospitals. If you want to visit out-of-network doctors, there is no need to provide a referral. However, it will be more costly. Cigna provides quality online services and is developing telehealth care services.
Humana was founded in 1961 and is one of the biggest companies based on membership. It started as a nursing home providing long-term care. However, it doesn’t offer individual medical insurance policies anymore. It is still in business when it comes to dental and vision insurance, offering PPO and HMO plans.
Kaiser Permanente is one of the leading not-for-profit health plans and healthcare providers. It has taken care of men’s health since 1945. Its headquarters are in California, and the company operates in Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia. For several consecutive years, Kaiser Permanente has been awarded by J. D. Power for scoring highest with customer satisfaction.
Kaiser also qualifies among the most affordable health insurance companies. However, it has a limited network of doctors and hospitals, so be sure to check what is offered in your area before going with Kaiser. The insurer provides excellent online support through its website and app. The company also is committed to providing quality health services to people who do not feel so confident with their English.
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United HealthCare is the largest health insurer in America, based on membership. It operates in all 50 states and has a vast preferred provider network. It offers both HMO and PPO plans. Its products meet the criteria for essential health benefits under the Affordable Care Act. It is among the more expensive health insurance companies, but it compensates with great online support. If you believe you should be able to manage your health and well-being online, UnitedHealthcare is the provider to select. You could order prescriptions through the internet, get in contact with a nurse over a hotline, track your deductibles, and find a doctor. There is also a useful app.
If you are not happy with your health insurance plan, the time to change is approaching soon. We hope this article made it easier to navigate through health insurance companies and their programs. Let us know what the most important thing you are searching for in insurance coverage.
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