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Top 10 Terms to Know When Shopping on the Marketplace - AB from MH Podcast EPISODE 3 - YouTube
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[Music]
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welcome to the ambetter from magnolia
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health podcast
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where we bring you information on and
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better health insurance and give you
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tools you can use to build a healthier
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life
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and better is health insurance available
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on the health insurance marketplace i'm
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your host becky martin with ambetter
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from magnolia health
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health insurance is complicated to sell
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health insurance
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a broker must take at least one course
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and memorize a four
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inch thick textbook to pass an exam and
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get their license
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they also have to keep that license up
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by getting a certain number of
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continuing education hours
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and reapply for that license every two
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years
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when we shop for health insurance most
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of us just want to know how much our
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premium will cost
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but there are so many unfamiliar terms
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it's
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easy to throw our hands up in
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frustration in this episode of the
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ambetter from magnolia health podcast
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i will give you the top 10 terms you
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need to know when you shop for health
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insurance on the health insurance
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marketplace
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and the great thing is no textbooks are
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required
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let's start with the term health
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insurance marketplace
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the health insurance marketplace is a
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service that helps people
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shop for and enroll in health insurance
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the federal government operates the
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health insurance marketplace
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and you can find it by going to
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healthcare.gov
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if you go to enroll.org
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you can enroll from that platform as
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well the health insurance marketplace is
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also known as
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the marketplace or exchange typically
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the marketplace is for people with no
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insurance people with employer-based
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insurance who pay
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over 9.78 of their household
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income on health insurance premiums can
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also shop the marketplace
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open enrollment open enrollment is a
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period of time
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each year when you can sign up for
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health insurance or
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change your plan for the health
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insurance marketplace this period is
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very
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short it's from november 1st through
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december 15th
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suppose you don't sign up for health
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insurance during open enrollment
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in that case you probably can't sign up
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for health insurance on the health
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insurance marketplace
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until the next open enrollment period
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unless you experience
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a qualifying life event a qualifying
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life
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event is a change in your life that can
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make you eligible for a special
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enrollment period
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these changes can include getting
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married having a baby
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losing your job etc a qualifying life
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event
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allows you to shop on the health
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insurance marketplace for health
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insurance
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outside of the yearly open enrollment
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period
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i mentioned premium earlier let's define
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that
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a premium is the amount of money a
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person pays an
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insurance company you have to make this
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premium payment
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each month to have insurance when you
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need it
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the cost varies by person and is
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determined by your
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income level that means what you claim
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when you file your income
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taxes when you shop on the health
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insurance marketplace
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you'll fill out an application the site
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will provide you with a selection of
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plans based on the level of coverage you
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indicated you need plus the amount of
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subsidy you might qualify for
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in order to help you pay for that
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insurance
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i just mentioned subsidy so let's talk
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about what a subsidy is
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if your income is between 100
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and 400 of the federal poverty level
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you may receive a subsidy in the form of
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an advanced premium
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tax credit or aptc the
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aptc is a tax credit you can take in
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advance
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to lower your monthly health insurance
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payment or premium
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when you apply for health insurance on
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the health insurance marketplace
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you estimate your expected income for
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the year
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if you qualify for a premium tax credit
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based on your estimate
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you can use any amount of the credit in
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advance to lower your premium
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many folks who make between 138 and 250
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percent of the federal poverty level who
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purchase a silver plan
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that's the and better balanced care plan
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pay nothing
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for their premium because of this
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subsidy what is the federal poverty
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level
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the federal poverty level is a measure
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of income
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and it's issued every year by the
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department of health and human services
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hhs the federal poverty level is used to
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determine your eligibility for certain
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programs and benefits
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and this includes savings on marketplace
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health insurance
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and medicaid and chip coverage for
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example
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for twenty twenty you are at one hundred
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percent of the federal poverty level
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if you're single and you make twelve
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thousand seven hundred sixty dollars a
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year
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if you're married family of two with a
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household income
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of seventeen thousand two hundred forty
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dollars a year
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or if you are a family of four with a
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household
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income of twenty six thousand two
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hundred dollars a year
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if your income starts around any of
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those amounts
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you may qualify for a subsidy to help
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pay for your health insurance on the
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health insurance marketplace
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you can find a health insurance
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marketplace calculator that will
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estimate your subsidy at the
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kaiser family foundation that's
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www.kff.org
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backslash interactive backslash subsidy
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dash calculator out of pocket costs
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out-of-pocket expenses refer to the cost
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that individuals pay
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out of their own cash reserves it's your
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share
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of the health insurance costs including
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money spent on deductibles co-pays
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and coinsurance preventive services like
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immunizations and annual wellness
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screenings
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are provided to you at no cost with a
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health insurance marketplace plan
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out-of-pocket maximum limit the most you
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have to pay for covered services
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in a year after you spend this amount on
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deductibles copayments and coinsurance
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for
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in-network care and services your health
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plan pays 100
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of the cost of covered benefits this
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doesn't apply to your monthly premiums
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anything you spend for services your
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plan doesn't cover
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out-of-network care and services or
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costs above the allowed amount for a
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service that a provider may charge
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deductible a deductible is the amount
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you pay for covered health care services
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before your insurance plan starts to pay
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for example with a two thousand dollar
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deductible
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you pay the first two thousand dollars
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of covered services yourself
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after you pay this deductible you
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usually pay only a co-payment or
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co-insurance for covered services
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copayment a co-payment is a fixed
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amount 20. for example you pay for a
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covered health care service
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after you've paid your deductible let's
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say your health insurance plan's
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allowable cost for a doctor's visit is
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100
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your co-payment for a doctor visit is 20
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if you've paid your deductible you pay
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twenty dollars
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usually at the time of your visit if you
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haven't met your deductible
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you pay one hundred dollars the full
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allowable amount for a visit
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co-payments sometimes called copays can
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vary for different services within the
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same plan like
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drugs lab tests and specialist visits
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generally plans with lower monthly
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premiums have higher co-payments
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plans with higher monthly premiums
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usually have lower copayments
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co-insurance this is the amount you
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pay to share the cost of covered
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services after you pay your deductible
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the coinsurance rate is usually a
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percentage
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for example if the insurance company
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pays 80 percent of the claim
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you pay the remaining balance of 20
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percent
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now what's the difference between
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copayments and coinsurance
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a copay is a set rate you pay for
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prescriptions
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doctor visits and other types of care
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coinsurance
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is the percentage of costs you pay after
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you've met your deductible
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a deductible is the set amount you pay
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for medical services and prescriptions
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before your coinsurance kicks in
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now that we've completed the vocabulary
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portion of this episode
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we'll start the exam gotcha i wouldn't
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do that to you
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if you need help navigating the health
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insurance marketplace
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it's completely free to talk to one of
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our mississippi
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and better health insurance brokers all
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you have to do
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is go to our website ambetter.magnolia
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ambetter.magnoliahealthplan.com
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click on plans and enrollment and then
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scroll down to
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find a broker from there you'll enter
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your zip code or your city
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and you can look up a broker who lives
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near you
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thank you for joining us for the
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ambetter from magnolia health podcast
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you can find this episode on our website
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ambetter.magnoliahealthplan.com
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remember to like magnolia help on
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facebook and subscribe to magnolia help
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on youtube to check
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for details on the next podcast ambetter
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from magnolia
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is underwritten by amber of magnolia inc
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which is a qualified health plan insurer
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in the mississippi health insurance
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marketplace
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and better of magnolia inc complies with
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applicable federal civil rights laws and
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does not discriminate on the basis of
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race color national origin
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age disability or sex this is a
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solicitation for insurance
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copyright 2020 ambetter of magnolia inc
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all rights reserved
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