The Health Care Law and You

The Affordable Care Act has changed the way that many people get health insurance. Individuals and families now have more options and more ways to get health insurance. If you are under the age of 65, turning 26 and aging off a parent’s health plan, or at-risk of losing your current coverage, explore your options and learn about how and where you can sign up for health insurance coverage.

2016 open enrollment has ended. Learn more about how you may qualify to buy a health plan during the special enrollment period.

Ways to Buy Health Insurance

You have four options when shopping for a health plan for yourself or your family:

  1. Shop for a health plan with Blue Cross and Blue Shield of Texas
  2. Attend a Think Blue event for free, in-person help
  3. Work directly with a Blue Cross and Blue Shield licensed insurance agent near you.
  4. Shop on the Health Insurance Marketplace

Costs to Consider When Choosing a Health Plan

Understanding health insurance costs and how they all work together is important. Your coverage will determine how much your monthly premiums are, what your deductible is and what your out-of-pocket costs may be.

Premium:

The premium is the amount you (or your employer) pay for your health insurance plan, whether you use medical services or not.

Deductible:

A deductible is the amount you will pay before the health plan starts paying for your covered services.

For example, if your deductible is $1,500, your plan won’t pay for some services until you’ve paid $1,500. In most cases, the higher your deductible, the lower your premium. The lower the deductible, the higher the premium.

TIP FOR CHOOSING YOUR PREMIUM AND DEDUCTIBLE
If you know you’ll be using your insurance often, you may want to choose a plan with a lower deductible. This means you’ll pay a higher premium each month, but the amount you pay when you go to the doctor will be less over the course of the year.This also works the other way. If you know you won’t use your insurance often, you may want to choose a plan with a lower monthly premium and higher deductible. This way you keep your monthly costs lower by taking the chance that you may not have a lot of medical expenses.

Coinsurance:

Coinsurance is the percentage of the cost that you will pay for a covered service. It applies after you meet your deductible.

For example, let’s say it costs $100 to see your doctor. If your coinsurance is 20%, you will pay $20 and the insurance plan pay $80. If you haven’t met your deductible, you will pay the entire $100.

Copayments:

A copayment is a fixed dollar amount you may have to pay at the time you get care. In most cases, it’s a small amount, such as $20 for a doctor’s exam. You won’t always have to pay copayments. The amount you pay depends on your health plan and which doctor you see.

Also consider your prescription drug copayments as part of your costs when choosing a health plan.

Out-of-pocket Maximum:

The out-of-pocket maximum is the most you have to pay during a policy period, most often 1 year.

Could a Health Savings Account (HSA) be Right for You?

A health savings account, or HSA, is a special kind of savings account for out-of-pocket medical expenses. HSAs can be a smart way to save for future or unexpected expenses, things like having a baby or medical emergencies.

HSAs can help you save money, too. You do not pay taxes on the money you put in your HSA – as long as you use the money for eligible out-of-pocket costs.

You must be enrolled in a high-deductible health plan (a plan with a higher deductible than most other plans) to open an HSA. And there is a limit to how much you can save to your HSA each benefit year.

Paying for Medical Care

After you receive medical care, you’ll typically receive a bill and an Explanation of Benefits.

  • Bills come directly from your hospital, doctor, or other health professional. Your final bill will show the services you received, the amount your health insurance plan paid and any payment you need to make.
  • An Explanation of Benefits comes from your health insurance company. It is not a bill. It shows what your hospital, doctor, or healthcare professional billed to your health insurance on your behalf, the amount your health insurance will pay for those services and any amount you may owe.

What happens if I choose not to buy health insurance?

You’ll pay a penalty if you can afford health insurance, but choose not to buy it. Not everyone will face a penalty, though.

For example, you won’t have to pay a penalty if:

  • You will be without insurance for less than 3 months of the benefit year
  • You have a very low income
  • You qualify for religious exemptions
  • You are a member of a federally recognized Indian tribe

Visit healthcare.gov for a complete list of exclusions.

How do I keep my coverage if I move out of state?

For information about how to retain your Blue coverage, call Blue, toll-free, at 1-888-630-BLUE (2583). Just enter the five-digit ZIP code for your new home address and you will be connected with a sales representative at your new Blue Cross and Blue Shield company who can help you find coverage that fits your needs and budget.

If you have questions about individual or family insurance plan, please call 888-809-2810 or visit bcbstx.com.