How to Balance Health Insurance Costs

Health insurance is a necessity, but it can be a big expense for a lot of people. That means that some people go without it in order to “save” money. But going without insurance can backfire, and end up costing you a lot in medical bills. We get it, though, the cost of some insurance plans can be surprising, or seem out of reach – but we’re here to tell you that it is possible to find affordable health insurance without breaking the bank. The best way to get started balancing your healthcare costs is to understand your plan and know what your options are.

Get Familiar with Your Expenseshand holding a calculator with the word cost on it and a hospital room in the background

There are a lot of expenses associated with your health insurance plan, and you need to know what you’ll be paying for when it comes to your plan. Here’s a breakdown of what you should be looking at:

  • Premiums– The amount you pay monthly for your plan.
  • Deductible– The amount you have to pay before your insurance company begins to pay for services. For example, you might have a $5,000 deductible, meaning you’ll have to reach that amount in out-of-pocket healthcare expenses before your coverage kicks in.
  • Copay– A set dollar amount that you pay when you visit a healthcare provider or emergency room, or for prescription medications. For example, you might have to pay $20 upfront to see your primary care physician, $30 to see a specialist, etc. 
  • Coinsurance– The percentage of costs that you will have to pay after meeting your deductible. For example, some plans will require you to pay 20% of a covered service, meaning if your health insurance plans’ allowed amount for an office visit is $100, you’ll pay 20% of $100, or $20 (if you’ve already met your deductible).
  • Out-of-pocket maximum – Health insurance plans now have a maximum amount that you will have to pay out-of-pocket for your healthcare expenses, so if you reach that limit in a calendar year, your insurance company will begin to cover your services in full.

Once you know how much you are paying for each of these parts of your healthcare plan, you can do some comparison shopping, and make sure that you have the right plan for you.

Know How to Save

Even if you’ve got a plan that works for your budget, you can still find more ways to cut down on some of your healthcare expenses.  For example, there are ways to save in the following situations:

When You Are in an Emergency

If you have a minor medical emergency, stop and think before you go to the emergency room, since a visit to the ER can be very pricey. For things that aren’t serious, try a telemedicine visit with your primary care physician, or visiting urgent care instead of waiting for an in-person appointment, or heading to the emergency room and being hit with a big bill. Depending on the situation, telemedicine or urgent care could be sufficient, and cheaper, if the issue isn’t life-threatening.

When You Need Blood Work

hand in purple gloves holding tubes of blood
Before getting blood work done, make sure the place you go to is covered under your insurance plan!

If your doctor orders blood work, make sure you find out which lab your insurance company requires you to use. Each insurance plan will cover certain labs, and some plans might require a referral or prescription, while others will not. If you go to the wrong lab, you will be stuck with a big bill for going to an out-of-network provider.

When You Need Outpatient Care

If you have to have minor surgery or a minor procedure, such as an ACL repair or a colonoscopy, you can save money by going to an ambulatory surgery center instead of the hospital. These centers will conduct same-day surgeries that cost less and are more convenient. 

Know What You Need

What exactly are you looking for in a plan? Do you have a family you need to cover?  Do you have kids who play sports, who will require a little extra coverage? Or are you single and need the bare minimum for the what-ifs? Whatever the case may be, take the time to determine what kind of plan and coverage you need. With all of the subsidies now available, there is no better time to reconsider getting a health insurance plan, or to look at your current one to make sure it covers your needs. 

And if your plan doesn’t cover everything you need it to, it’s time to find a plan that does, so you can save as much money as possible. If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan fits your budget. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890. No obligation.

What the No Surprises Act Means for You

One in five Americans have received a surprise medical bill from an emergency department, and another one in five have gotten unexpected bills from non-emergency hospital stays. Surprise medical bills have been a huge problem for Americans, but on January 1, 2022, the No Surprises Act took effect. This law establishes federal protections against most surprise medical bills that come after you receive out-of-network care during a hospital visit. Find out what the No Surprises Act means for you.

Surprise Bills

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Surprise bills can be scary and overwhelming, but now you can worry no more!

In some cases, when you receive medical treatment (especially in an emergency situation), you will be unable to choose the provider who treats you, and so you end up unexpectedly receiving care from an out-of-network provider. Or, you might visit an in-network facility, but unknowingly see an out-of-network provider during your stay there. 

Your insurance company will often pay some amount to the out-of-network provider, but typically less than the provider’s list price for the services. In most cases, the provider who treated you will then “balance bill” you for the difference between their list price and the insurer’s payment. In other cases, your insurer will offer little to no coverage of your unexpected out-of-network care. And in both of these scenarios, you’ll end up getting an unexpected bill, known as a “surprise” medical bill. 

Getting a surprise medical bill in the mail can be a source of a lot of anxiety for many people. Two out of three Americans say they worry about being able to afford unexpected medical bills, and nearly half can’t afford to pay surprise bills in full. 

Ending Surprise Bills

But the No Surprises Act will now make surprise medical bills a thing of the past. The law bans:

  • Surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand.
  • Out-of-network cost-sharing (like coinsurance or copayments) for most emergency and some non-emergency services, so you can’t be charged more than in-network cost-sharing for these services.
  • Out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) administered by out-of-network providers as part of a patient’s visit to an in-network facility.

 In addition, according to the law, you can’t be asked to waive your protections against balance billing in emergencies or for certain non-emergency services, such as ancillary services (anesthesia, pathology, radiology) associated with emergency care, or diagnostic services such as radiology or labs. It will be up to medical providers and insurers to identify which bills are subject to the Act.

“This law puts an end to the practice of charging patients exorbitant bills for unexpected, out-of-network care,” Sen. Patty Murray, chair of the Senate Health, Education, Labor, and Pensions Committee, said.

What the No Surprises Act Does Not Cover

Unfortunately, the bill does not ban all surprise and out-of-network bills. It will exclude: illustration of an ambulance

  • Ambulance rides– The law applies to air ambulances, but not ground ones.
  • Certain facilities– The law applies to hospitals and emergency departments, but not to other facilities, such as urgent care facilities.

If you are unsure if a bill you received in the mail falls under the No Surprises Act, or if you have general questions about the new law, contact the newly established No Surprises Help Desk at 800-985-3059.

Find A Better Health Plan

Unfortunately, sometimes you will find that your health insurance plan doesn’t cover everything you need it to, leaving you with a big bill that you will have to pay out-of-pocket. If your plan isn’t adequate for your needs, it’s time to find a plan that is, so you can save as much money as possible. If you’re shopping for a plan, your best bet is to speak to a licensed EZ agent. Our agents work with the top-rated insurance companies in the nation, so we can compare plans in minutes. We will not only find a plan that has all the benefits you’re looking for, but we will also make sure the plan fits your budget. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890. No obligation.

What Are the Federal Poverty Levels (FPL)?

Your salary and any other money your family brings into the household determine how much you will pay for health insurance. Why? Because, depending on what your salary is in relation to the Federal Poverty Level (FPL), you could qualify for tax subsidies that will reduce your premiums. Learning about the Federal Poverty Level can help you in your search for an affordable health insurance plan.

Federal Poverty Levels for 2022

To know if, and what kind of, subsidies you qualify for when it comes to health insurance, you’ll need to know how your salary relates to the Federal Poverty Level. The following are the 2022 Poverty Guidelines for salaries in the 48 Contiguous States and the District of Columbia: silhouette of a family of 4

  • $13,590 for individuals
  • $18,310 for a family of 2
  • $23,030 for a family of 3
  • $27,750 for a family of 4
  • $32,470 for a family of 5
  • $37,190 for a family of 6
  • $41,910 for a family of 7
  • $46,630 for a family of 8

For families/households with more than 8 persons, add $5,900 for each additional person.

Federal Poverty Level amounts are higher in Alaska and Hawaii. Alaska starts at $16,990 for an individual,  and Hawaii starts at $15,630 for an individual.

Federal Poverty Level Cut-Offs

The FPL for a given calendar year plays a key factor in determining eligibility for reduced-cost health care and health insurance. If your salary is at or below certain percentages of the Federal Poverty Level, you qualify for Marketplace subsidies. The FPL cut-off is:

  • Annual income between 100% and 400% of the FPL 

In all states, if your income level is in this range, you will qualify for premium tax credits for ACA health coverage, which can lower your monthly premium for a Marketplace health insurance plan.

moneybag with bills in it
Now you can save even more money thanks to Biden’s Rescue Plan Act.

This cut-off is fairly new: President Biden extended subsidies to more Americans with the American Rescue Plan Act, so that those who earn up to 400% of the Federal Poverty Level can now receive subsidies to purchase health insurance through the ACA Marketplace. The ARP also requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance.

As of April 1 of this year, anyone buying their health insurance through the ACA Marketplace is able to receive the tax credits if they qualify. 

Looking for health insurance? Comparing plans is the best way to find an affordable plan that provides the right level of coverage for you. Before you start doing the work of comparing on your own, come to EZ. We will make the process quicker and easier by comparing available plans in your area in minutes. Our licensed agents work with all the top-rated insurance companies in the nation and can go over your budget and needs, and find the best plan for you and your family. We compare plans and offer guidance at no cost to you. To get free quotes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-350-1890.

If You Missed The Covid Special Enrollment Period, You’ve Got Another Chance To Sign Up!

Life can get pretty hectic, so it’s totally understandable if you missed out on the Covid-19 Special Enrollment Period, which ran from February to August of this year, and allowed Americans to sign up for health insurance outside of the usual Open Enrollment Period. But if you’re kicking yourself for not changing your plan or enrolling in a plan when you had the chance, don’t worry! You now have the opportunity again to find a great plan and save money: the ACA Open Enrollment Period started November 1st and will run through December 15 in most states, with an extension into January for others. Don’t miss out again on finding a great affordable plan!

Know Your Deadline!

a red circle with the word deadline inside of it multiple times around
Depending on the state you live in, your deadline might be longer.

As we mentioned, some states have different Open Enrollment Period deadlines. The deadline to change or sign up for a plan in most states is December 15, except for:

  • California: January 31
  • Colorado: January 15
  • Connecticut: January 15
  • Idaho: December 31
  • Massachusetts: January 23
  • Minnesota: December 22
  • Nevada: January 15
  • New Jersey: January 31
  • New York: January 31
  • Pennsylvania: January 15
  • Rhode Island: December 31
  • Washington DC: January 31

Extra Savings You Can Get Now

The Covid-19 pandemic has taken a toll on everyone, and the government took initiative to try and help Americans stay protected by opening the Special Enrollment Period in February, but that is not all they did. President Biden has also extended extra savings to Americans signing up for health insurance: his American Rescue Plan (ARP) is allowing more Americans to qualify for premium subsidies. Now, households with income up to 150% of the federal poverty level are eligible for subsidies that fully cover the cost of the benchmark plan, meaning they can select either of the two lowest-cost Silver plans and have no monthly premium.

Not only that, but the American Rescue Plan Act also allows those who earn over 400% of the federal poverty level to receive subsidies to purchase health insurance through the ACA Marketplace, requires that Americans pay no more than 8.5% of their income on health insurance premiums, and provides a larger tax credit to people who already receive financial assistance. Depending on your family size and income level, you could pay as low as $0 for a plan, or save up to $1000 a month in premiums. 

Save More With EZillustration of a man in a suit with a graph going upwards and a coin money sign above the graph

We get that trying to find a great plan while saving as much  money as possible is not easy; it can be time-consuming and downright frustrating. But EZ is here to help: our agents work with the top-rated insurance companies in the nation, making it easier and faster to compare plans in your area. In fact, we can compare plans in your area for you and your family in minutes! We will provide you with an agent who will find a plan that covers your medical needs, and will allow you to stay within your budget. 

And unlike other companies who just want to make a dime off you, we just want to help you stay healthy by finding a great plan that won’t break the bank. That’s why all of our services are free! Let an EZ agent start comparing plans for you now, before Open Enrollment is over. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a licensed local agent, call 888-350-1890.