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How to choose a health plan

Tufts Health Plan
How to choose a health plan

Having health insurance is one of the most important things you can do for yourself and your family. It makes getting the medical care you need easier and more affordable, whether it’s for a serious illness or injury, or the routine appointments and medications you need to stay healthy. Having access to affordable care is especially important now, during the COVID-19 pandemic, so you can get the medical advice and care you need to keep yourself and your loved ones safe.

In Massachusetts, everyone is required to have health insurance. Residents who need to buy individual or family health insurance have the chance to buy or enroll in a new health insurance plan between Nov. 1 and Jan. 23 each year. This period, called “Open Enrollment,” is the only time you can sign up for a new plan or switch from your current one. After the deadline, you must have a “qualifying life event”—like getting married, losing a job, having a child, or losing your existing health insurance—to enroll in a new health plan. If your circumstances change, you can enroll in MassHealth any time of the year if you qualify. You may be charged a tax penalty if you don’t have health insurance.

Getting started: Find out if you qualify for financial help

Many people get their health insurance through their employer. But what if you don’t have a job that offers health insurance as a benefit? Where do you start, and how can you get financial help if you need it?

The first step is to visit the Massachusetts Health Connector (www.MAHealthConnector.org). There, you’ll fill out an application to see if you qualify for financial help. Your eligibility is based on your household income, family size and other factors.

If your income is below a certain level, you may qualify for subsidies and/or advanced premium tax credits. These are types of financial help from the government that can help keep the monthly cost of coverage low. A new law, called the American Rescue Plan, provides added financial help for health insurance premiums. People who got help in the past may qualify for more help. And some people who were not eligible for help in the past can now get help. To get these savings, you must enroll through the Health Connector. If your income is above a certain level, you’ll need to pay your own premiums and out-of-pocket costs.

What to look for in a plan: How to compare coverage and costs

There are literally dozens of health plan options to choose from on the Health Connector. It can feel overwhelming. Before you jump in and start comparing and contrasting, it’s a good idea to take a step back and think about the kinds of health care coverage you and your family need.

Are you and/or your family members young and relatively healthy, or are there existing health issues or conditions that you know you’ll need coverage for? Do you typically go to medical appointments on a regular basis, or just one or two times a year? Does anyone in your family take prescription medications regularly? Knowing the answers will help you evaluate each plan and decide which one is the best fit.

Next, brush up on your insurance vocabulary. When you compare plans, consider these amounts:

Premium The amount you pay each month.

Copayments The dollar amount you pay for medical services and prescriptions.

Coinsurance The percentage of costs you pay for medical services and prescriptions.

Deductible The amount you need to pay before the health plan starts to cover services.

Out-of-pocket maximum A limit or cap on how much money you have to pay for services in a year, including deductibles, copayments and coinsurance.

To make it easier, the Health Connector groups all available health plans from all insurance companies into four different categories: Platinum, Gold, Silver, and Bronze. Platinum plans are designed for people who are likely to be using their health insurance frequently. They may have health conditions, multiple prescriptions, and go to the doctor or hospital often. These plans have the highest monthly premiums, but the lowest out-of-pocket costs.

At the other end of the spectrum are Bronze plans. These plans are designed for people who consider themselves healthy. They don’t take costly prescriptions on an ongoing basis and don’t go to the doctor or hospital often. The monthly premiums for Bronze plans are the lowest, but out-of-pocket costs are higher. The Gold and Silver plans fall in between Platinum and Bronze.

Beyond dollars and cents: Other factors to consider

Cost isn’t the only thing to think about when it comes to choosing a plan. You’ll also want to see if the plan you choose covers your existing doctors and providers—assuming you want to keep using them—and whether it will cover any ongoing prescription medications you take. Usually, you can find this information by visiting the health plan’s website or calling their customer service number.

This is also a good opportunity to see whether the health plan’s website is helpful and easy to use and/or if their customer service representatives are friendly and knowledgeable. It’s important to be able to get answers and information when you need them.

Finally, take a look at the extra perks and benefits different health plans offer to help you stay healthy and save money. This might include rebates for the cost of your gym membership, nutrition coaching, or discounts for safety equipment or products. Little benefits like these can add up. Members of Tufts Health Direct plans, for example, get perks like access to a professional dietitian or health coach, money back for fitness activities like gym memberships, extra discounts at CVS and a free fitness band or $25 supermarket gift card just for getting a yearly checkup—to name just a few.

Choosing a health plan takes a little time and effort, but it’s worth it. The right plan will help you keep yourself and your loved ones healthy without breaking the bank. At Tufts Health Plan, we offer comprehensive coverage, valuable perks, and answers when you need them, through our Tufts Health Direct plans. It’s all part of our commitment to being there for our members, giving them the support they need to live a healthier life.

Tufts Health Plan is one of the few health plans in Massachusetts to offer coverage across the life span regardless of age or circumstance. This coverage includes Medicaid/subsidized, commercial and Medicare health plans. To learn more, visit tuftshealthplan.com.

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