With the election of Donald Trump, the future of the Affordable Care Act is now in jeopardy: As a candidate, President-elect Trump promised to repeal it, but it's unclear what he'll do once he takes office in January. Many of those in Congress have expressed skepticism that the law can be repealed all that easily. Under the law, more than 20 million Americans have received coverage.
However, most agree that, no matter what happens, the current exchanges will last until at least 2018, if not 2019.
In short, if you don't get coverage via your employer. You will still need to pick a plan. If you do get coverage through your employer, you will still need to pick a plan.
Make sure your plans covers what you need it to cover
Do you have a doctor you life? Then make sure they are in insurance provider's network of accepted or preferred practitioners. Going out of network in an HMO plan could be exceptionally expensive, and out-of-network costs typically don't apply to your deductible or out-of-pocket maximum.
Many years ago, I found a therapist I liked, but had to pay for my sessions out of pocket for a couple of months until I could switch my health insurance to a plan that covered her. Once I switched, my weekly sessions dropped from $80 a pop to nothing more than a $15 co-pay. (This was a while back, before high deductibles became a de rigeur.)
Similarly, if you want access to less obvious benefits like acupuncture or vision care, you should check to be sure your plan covers that.
Consider the tradeoff between higher premiums and lower deductibles
If you're healthy and young (like many of our readers), then a high deductible plan might make sense. You don't anticipate visiting the doctor all that much, or racking up all that many expenses. In that case, it's logical to want to get your premiums down to reduce your expected overall costs.
But if you've got known health issues, or need particular medications, then a high-deductible plan doesn't make as much sense. You know you'll have high costs, and thus you'll want the insurance to kick in as early as possible. In this case, it might be worth paying more per month so that you won't be saddled with three -- and four -- digit bills for too long.
It's not all that different from how you'd evaluate other prospective purchases: If you're going to use something a lot, it makes sense (both financial and otherwise) not to scrimp. If you think you'll use something rarely, it's probably okay to go for something a little more cut-rate.
The differences between an HMO and a PPO
HMO are known for "managed care" which means they offer lower costs in exchange for less flexibility -- i.e. you have to see the doctors in their network, and you'll have to get a referral from your primary care doctor to see a specialist.
PPOs, on the other hand, offer more flexibility but higher costs. You can see doctors you like -- even if they're not in your insurance's network of preferred providers -- and often don't need a referral to see a specialist. But they usually cost more, and it's possible your out-of-network costs won't apply to your out-of-pocket maximum.
The best solution, of course, is to find an HMO that has your preferred doctor or hospital within its network.
Like the choice between premiums and low deductibles, it's all about what matters most to you and what you're willing to compromise on.
For the young and healthy, consider an HSA-eligible plan
One of the biggest headaches of the ACA affects those who make too much to qualify for tax subsidies (i.e. more than 400 percent of the poverty level) but who don't make quite enough to easily absorb the premium increases expected in 2017.
First, let's talk about tax subsidies, because it's not just your income that determines whether you're eligible. It's also determined by the cost of the second lowest cost Silver plan in your state. (Plans on the ACA exchanges are classifieds as Bronze, Silver, Gold, or Platinum.) Your expected contribution to your health insurance is determined by how much you make and by how much a benchmark plan costs. If you're between 300 and 400 percent of the federal poverty level, then you will be expected to contribute up to 9.69 percent of your income to health insurance costs.
So if you make less than 400 percent of the federal poverty level but aren't eligible for subsidies, that's why. If plans in your area were more expensive, or you made a little less money, you might be eligible.
Why an HSA-eligible plan might be your best option
If you find yourself in this situation, the best solution (provided you're relatively young and healthy) is to get one of the HSA-eligible ACA plans.
HSAs, or Health Savings Accounts, allow you to put away money (tax-free), which can then earn interest tax-free, and be withdrawn (also tax-free) to be used to pay for out-of-pocket medical expenses. To be eligible for an HSA, your health plan has to meet the criteria of a High-Deductible Health Plan (HDHP) -- which means a deductible of at least $1,300 for an individual, and $2,600 for a family.
These plans tend to be (but aren't always) Bronze plans, and thus have lower premiums but higher deductibles. If you do require care (and once you've hit your deductible) they cover less than Silver or Gold plans.
If you're young and don't expect to use your coverage all that much, then one of these plans is a good way to a) reduce your financial outlay in the form of premiums and b) to start socking away money for Future You, who's gonna be older and more likely to need care.
In addition, any money you put into an HSA will lower your taxable income, making you more likely to be eligible for subsidies. (Again, those subsidies may go away pretty soon, but we can't know that for sure.)
Regardless of what plan you pick, make sure you take advantage of any "free" benefits it provides
If you're young and healthy and have a high-deductible plan, it can sometimes feel like you're getting a lot of nothing for your premiums.
That's why it's good to take advantage of all of the free benefits that come with an ACA-compliant plan -- things like immunizations, yearly check-ups, and reimbursements for gym memberships. These are tangible benefits you can see and feel (in your wallet).
But even beyond that, remember that you're not exactly getting nothing for your premiums. The point of insurance (and in health insurance this sometimes gets lost) is to guard against risk (and spread out that risk over a lifetime), and these plans, while not ideal, will keep you from going into huge amounts of debt should you get into an accident or come down with a serious illness.
And while you may be paying more now than you're getting back, that will change as you age, and need more care.
Remember
Shopping for health insurance is not any fun. But health insurance is an essential bulwark against financial ruin, as a significant percentage of those who declare bankruptcy do so due to medical bills. When choosing a health plan, consider what's most important and what you can live without. And if you're young, consider an HSA-eligible plan, which can lower your costs now and let you save up money to pay for your care down the road.
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