Health Insurance Plans in Charlotte, North Carolina
There are many different health insurance plans that cover varying degrees of counseling and medical costs based on the type of plan you have and also based on the medical providers status with that insurance company. Generally, if the provider is part of the insurance network that you have, the cost of receiving treatment will be less. Here are some things to look at:
Simply put, the network that your health insurance coverage provides is the contracted group of healthcare professionals that can accept your health insurance card. This can include labs, x-rays, primary care physicians, psychiatrists, psychologists, drug and alcohol rehabs, and other professional services. Each health plan and coverage generally has a different number of options for each service in your area. As the size of the network increases, so does the number of doctors, physical rehabs, hospitals, and other health facilities that are available to you under coverage: however, as the size of the network grows, so does the cost of the monthly premium.
Plans that use a local network often cost less, but usually only have a few doctors, facilities, and one major health system in-network. These local network plans are often limited to a county or city as well.
2. Copayments, Deductibles, and Coinsurance Plans
There are two main types of health insurance plans: deductible /coinsurance plans and copayment plans. The name of the plan will determine how you’ll pay for the health service, pharmacy, doctor, rehab, or hospital.
- Copayments: A copayment is the flat rate that you pay for an in-network service during the treatment. For example, if you walk into a doctor’ office, you’ll be paying a $20 copay instead of a $250 out-of-pocket charge. Copay plans tend to be more expensive, but offer more coverage.
- Deductible: A deductible plan sets a dollar amount that you’ll have to pay before health coverage kicks in.
- Coinsurance: A coinsurance is simply your share of the bill that you split with your health insurance based on a pre-determined rate.
The amount that you’ll have to pay in terms of the copayment, deductible, and coinsurance rate is dependent upon the level of plan you decide to go with. You’ll typically spend less in deductibles and copayments with a higher level plan, but you’ll also spend more in a higher monthly premium. You should consult with your health insurance carrier or a licensed insurance expert to fully understand the costs of your plan.
3. Level of plans (Metallic Levels)
The level of a heath insurance plan is based around the 2020 Affordable Care Act (ACT). The metallic levels (bronze, silver, and gold) were created by the ACA to represent the value of coverage that a particular plan offers. The higher the monthly cost, the more the plan will pay on medical costs on average. This tiered system allows you to easily compare co-payments, deductibles, coinsurance percentages, and the monthly premiums you’ll pay. More coverage may make more sense for some people, while less coverage may make sense for people who do not run into very many medical bills. This information is all an estimate and not an actual representation of what your insurance plan will cover:
- Bronze: These plans will pay for roughly 60% of your medical costs and you’ll pay the remaining 40%. Good for individuals who do not need a lot of monthly care, and only want protection from the worst-case medical scenarios, such as trauma care. The monthly premium will be lower, and most of the routine coverage scenarios will have to be paid for by you.
- Silver: These plans will pay for roughly 70% of your medical costs and you’ll pay the remaining 30%. If you are willing to pay a higher premium than bronze to have more routine medical procedures covered, this is the way to go.
- Gold: These plans will pay for roughly 80% of your medical costs and you’ll pay the remaining 20%. These plans are used by people who need a lot of care month by month and are willing to pay more in monthly premiums.
For example, the high monthly premium cost of the Gold tier may be worth it if you have a large number of routine visits per month, such as monthly psychiatrist, psychologist, and treatment visits. The higher the tier of the plan, the larger your network will be. Depending on your own individual situation, you may qualify for subsidies to help pay for your insurance.
A subsidy is a type of financial assistance that is offered by the federal government to help make health insurance cost-effective for the average American. There are many variables that can qualify a family and an individual, based on their household size and their income. The two types of subsidies are known as Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs).
To qualify for financial assistance under new health coverage, you must:
- Live between 100%-400% of the Federal Poverty Level (FPL)
- Not be eligible for other federal or public coverage, such as Medicare, Medicaid, coverage through the armed services, or the Children’s Health Insurance Program (CHIP)
- No access to affordable insurance through your employer. These standards are defined by the health marketplace based on the percentage of a premium you would be responsible for.