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Existing subscribers have been renewed since the 1st.
Also consider an income-based enhanced silver plan.
While the official ObamaCare sign-up period has begun, renewal applications for existing subscribers have already been in process since the 1st.
California residents who have not had health insurance until now must sign up for Obamacare as well as general health insurance during this sign-up period. After this period, unless there are special reasons, subscription to health insurance is restricted.
If you quit your job and lose your employer’s health insurance, move out of state, discontinue Medi-Cal health insurance, or add a newborn or married spouse to your existing health insurance, you can sign up at any time of the year. Excluding this, it is not possible to sign up for health insurance outside of the sign-up period, so you have to wait until next year’s sign-up period. Therefore, Koreans considering signing up for health insurance are recommended to seek professional advice as soon as possible.
New subscribers as well as existing subscribers must choose a plan every year, and in this case, the first thing they are faced with is whether to choose between HMO and PPO.
The biggest characteristic of an HMO is that it selects a Primary Care Physician. The primary doctor is usually chosen between internal medicine and family medicine.
When specialist treatment in a specific field, such as gastroenterology or cardiology, is required, prior approval from the insurance company must be obtained through the attending physician, and tests such as gastroscopy, ultrasound, and MRI are all performed through the attending physician.
On the other hand, in the case of PPO, you can go directly to a specialist without this process, but in this case, you must use a doctor or hospital (In Network) that has a contract with the insurance company. Otherwise (Out of Network), you will not receive a discount on hospital fees. In addition, the patient is also responsible for paying the difference between the amount paid by the insurance company and the amount charged by the hospital.
Once you have chosen an HMO or PPO, you can choose one of four plans: Bronze, Silver, Gold, and Platinum. Of course, the bronze plan is the cheapest and has the weakest insurance coverage, and the platinum plan has the most benefits, but the premiums are expensive. If you are a household with an income less than 200% of the federal poverty level, you can sign up for the Enhanced Silver Plan, which can be considered to have better benefits than the Platinum Plan.
When understanding insurance coverage, there are four important factors: deductible (deductible), copay (out-of-pocket medical expenses), coinsurance (out-of-pocket ratio of medical expenses), and OOP (annual out-of-pocket limit).
The deductible is the amount you must pay first out of the amount billed by doctors and hospitals after medical treatment is performed. If the deductible is $2,000, insurance benefits begin after you pay this amount each year.
A copay is an amount that subscribers must pay when they see a doctor. If the copay is $30, they must pay $30 each time they see a doctor. Coinsurance is the percentage of medical expenses borne by the subscriber after the deductible is met. If the coinsurance is 20%, the subscriber must pay 20% of the remaining amount excluding the deductible.
Lastly, OOP sets the maximum amount you can pay per year, including deductibles, co-pays, and coinsurance.
Signing up for medical insurance by carefully reviewing the above provisions and receiving advice from an insurance expert will be a wise choice for future insurance use.
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Alex Han / Financial Insurance Expert
