Health insurance is an incredibly important part of accessing healthcare. Without insurance, the cost of medical care can sway you from seeking medical treatment early on and cause you to delay being seen until the condition is so bad you may need to be seen in the ER. Preventive medicine and early treatment allow for better health outcomes, less sick days at work, less chronic conditions, and being able to live your daily life to the best of your abilities. In 2010, former President Barack Obama signed into law the Patient Protection and Affordable Care Act (often shortened down to the Affordable Care Act or the ACA), which sets up new rules and regulations that insurance companies needed to abide by to comply with the federal statute. The ACA’s website, Healthcare.gov, launched in October 2013. Though there were some initial problems with the site, it eventually got off the ground and is now working well, providing information on plans and enrollment to interested consumers. Before picking a health insurance plan, there are some things you should know so that you can navigate the website successfully and select the best plan for your needs. Firstly, understand that when it comes to health plans there is no “one size fits all” motto.

When seeking to understand your healthcare costs, there are some terms you need to know. These include premium, deductible, copayments, and out-of-pocket payments. In addition to knowing what each of these means, when selecting a plan, you should also be able to estimate the total amount of care you’ll need. This estimate will be a rough one, as no one can know for sure how much health care he or she will need that year. Terms to Know: Premium: this amount is paid to the insurance company every month as the cost of having a policy. Deductible: your deductible is how much you must spend for healthcare costs before insurance will pay. This excludes free preventive services. Copayments: every time you get a medical service after your deductible is paid, you will pay a copayment. This cost is how much out of the total expense of your care that you must pay out-of-pocket. Out-of-pocket payments: these payments are ones you make on your own. There is a maximum amount with the ACA. After you’ve reached the maximum, the insurance company must cover 100% of your costs for covered services. Estimating Your Yearly Care Amount This estimate is not a simple one, as no one can predict the future.

For health insurance, there are different network plans that affect who you can see in-network and who share the costs of your plan. These plans are available at all different metal level types and can be found in the marketplace in a wide range. These include an Exclusive Provider Organization (EPO), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and Point of Service (POS) plan. All of these plans vary based on network requirements and cost-sharing functions. Here are some brief descriptions below: Exclusive Provider Organization (EPO): With this plan, services are only covered if they are obtained within network—meaning, obtained from doctors and other medical specialists who work with the plan’s insurance. Services obtained out-of-network, with exceptions for emergency situations, are not covered. The plan works exclusively with in-network providers (hence the name). Preferred Provider Organization (PPO): If you use providers that are within the plan’s network, you pay less than if you use out-of-network providers. While you can use out-of-network providers and you will be covered, you will have to pay more and your care will have an additional cost added to it. If you are obtaining services from out-of-network providers based on a referral from an in-network provider, you will likely not have that additional cost tacked onto your care (though, for the most part, referrals tend to be amount in-network providers).

The most common age for someone’s Medicare coverage to begin is 65. The enrollment for Medicare takes place three months prior to your 65th birthday and the period extends until three months after that birthday. A common question that marketplace plan holders at that age encounter is how to change from their marketplace plan to Medicare. While Medicare is not part of the marketplace, the type of Medicare plan you have is still scrutinized by the new as to whether you have sufficient coverage. If your Medicare does not cover your health care fully, you may be considered uninsured under the law and therefore penalized. If you have just Medicare Part A (hospital insurance), you are considered covered under the law, but if you only have Part B (medical insurance) you are not considered to have coverage and may have to pay a fee as a result. Under the ACA, Medicare benefits have expanded—preventative care, wellness, and cancer screenings are all covered under the law and there is often opportunity to save money on prescription drugs depending on your plan. Making the Switch As mentioned, the enrollment period for Medicare lasts six months, with the applicant’s 65th birthday as the central point.

If you’ve been following the discussion surrounding the ACA, you may have heard the term “Essential Benefits” thrown around. This term refers to what plans must cover to comply with the law. These are the minimum requirements of an insurance plan. The benefits include a range of preventative services, preexisting conditions, and other vital healthcare costs that could financially harm a person if he or she had to pay for them all by themselves. Here are the ten essential benefits that insurance plans must cover: Ambulatory Services:  This refers to outpatient care you receive without being admitted to the hospital. Hospitalization:  This requirement includes coverage for overnight stays and surgery. Emergency Services:  Services that occur in the emergency room and are extremely urgent in nature. Pregnancy/Newborn Care:  This coverage includes pregnancy, maternity, and newborn care both before and after the birth of the infant. Mental Health and Substance Abuse Care:  Counseling and therapy are two integral parts of this minimum requirement. Rehabilitative Services: these services include those that help people with injuries, disabilities, and/or chronic disorders who require therapy to regain physical and cognitive skills. Preventative Services: also known as “wellness” services, these include management of chronic diseases. Laboratory Tests: