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The beginner’s guide to health insurance

Choosing health insurance can be overwhelming, especially if it’s your first time doing so. Whether you’re getting insurance from your employer or finding a plan on your own, you’ve come to the right place. By learning about the different types of plans, out-of-pocket costs and how you can save with Health Savings Accounts (HSAs), you have a fighting chance of keeping your health bills in check—so a broken leg doesn’t also break the bank.

Know your options

Got an employer, a spouse or domestic partner, or (if you’re still under 26) parents with a good health plan? If so, maybe you can get covered through them. As another option, you might qualify for a state or federal program or be able to buy a policy through a state or federal exchange; you can explore those options online. To learn more, you can use plan comparison tools—offered by exchanges or your employer—and even ask family, friends and colleagues for input on which plans work best for them.

Research your plan

Health insurers will negotiate the costs of, and generally help you pay for, any care that is covered. The best way to find out what that includes—ideally before you buy—is to check the Summary of Benefits and Coverage, which your employer or the exchange you’re shopping on will provide.

Your plan likely won’t cover everything: Often things like acupuncture and cosmetic surgery are excluded, which means you’ll pay full price. Plus, dental and vision care usually require separate plans. However, your plan may help defray the cost of wellness-related activities, like yoga or a gym membership.

Try to understand exactly what’s covered and how much you have to contribute for your care, especially if you know you have specific needs or chronic conditions.

Plans may differ based on the network of doctors and hospitals they include and the specific services and prescriptions they cover. The best way to determine whether your doctors are in-network is to call and ask them. You can also call the insurer or check its online directory. Your plan may also cover care from an out-of-network doctor or hospital. However, it may have a different payment structure, and you should make sure you understand the difference in pricing.

In addition, the costs of plans can vary. Some plans charge higher premiums and pay more toward your care—on state and federal health insurance exchanges, these are designated platinum or gold. Others have lower premiums, and you are responsible for more of the care costs—on the exchanges, these are silver or bronze plans, or (if eligible) so-called catastrophic plans.

Some plans are compatible with Health Savings Accounts (HSAs), which you can fund with income that won’t be subject to federal income tax, although state income taxes may apply. You can use the money in the account for any eligible out-of-pocket health costs, and the tax advantages can save you money.

Review the costs

Even if you never step foot in a doctor’s office, you have to pay your health insurance premium, an amount paid periodically to the insurance company to keep your policy active. With an employer-provided plan, your portion of the premium might be deducted from your paychecks. If you buy a plan through a state or federal exchange, you might qualify for a subsidy that reduces the amount you pay. For the remainder, or if you buy directly from an insurer, you must send in a check or pay electronically.

Once you actually go to a doctor, you’ll likely incur more costs. Currently, the law requires your insurer to cover certain preventive visits and tests at no charge to you. But most other care results in a bill. Before you visit your doctor, check to see what’s covered so you don’t get caught off guard. Here’s how you and the insurer split those costs:

This is a fixed dollar amount you pay for certain kinds of care. It might be $40 for each visit to a specialist or $100 if you go to an urgent care center.

This is the amount you have to pay before the insurer starts to pay. It might only apply to certain kinds of care, such as blood tests or a hospital stay.

This is typically expressed as the percentage of the total negotiated cost that you must pay. It may only apply to certain things.

Brush up on plan limits

The law limits your out-of-pocket maximum for covered care, although that may still be a hefty sum.

For 2020, the maximums are $8,150 for individuals and $16,300 for families, if you stay in-network. In 2021, those figures are $8,550 and $17,100.

Depending on the plan you choose, the out-of-pocket maximum may be lower. For out-of-network care, the out-of-pocket maximum could be significantly higher and has no mandated cap.

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Out-of-pocket maximums

  Individuals Families
2020 $8,150 $16,300
2021 $8,550 $17,100

In between jobs?

No job doesn’t mean no health insurance. COBRA, the Consolidated Omnibus Budget Reconciliation Act, allows you to pay premiums for and keep your group health insurance whether you quit, lose your job or reduce hours. It usually lasts 18 months. You can learn more about COBRA here. As a possible alternative to COBRA, or if you’re planning to go freelance after COBRA expires, you should also research the available options under state and federal exchanges.

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The material provided on this website is for informational use only and is not intended for financial, tax or investment advice. Bank of America and/or its affiliates, and Khan Academy, assume no liability for any loss or damage resulting from one’s reliance on the material provided. Please also note that such material is not updated regularly and that some of the information may not therefore be current. Consult with your own financial professional and tax advisor when making decisions regarding your financial situation.

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Bank of America and its affiliates do not provide legal, tax or accounting advice. You should consult your legal and/or tax advisors before making any financial decisions.