A common question I get from clients who are looking for individual health insurance is, “What plans are available to me under Obamacare?” “Which plans have my doctor or hospital in network?” “How do I pick between my options?”
If you are in the market for individual health insurance in the Saint Louis/Saint Charles area, I can help. Our agency handles every aspect of the Affordable Care Act, including walking you through the www.healthcare.gov subsidy process (the only way to get lower premiums). Give us a call at 636-561-5060 for guidance. We do not charge any fees for our assistance.
Ultimately, you will have 3 specific options to choose as of 2014. They are:
- Anthem Blue Cross and Blue Shield
- CoventryOne PPO
- CoventryOne Carelink
Any policy you purchase as an individual should come from one of these insurers. What are the differences?
Anthem Blue Cross and Blue Shield
Anthem’s plans tend to be lower priced with lower deductibles (the amount you pay if you have a test like an MRI before your insurance begins). However, you do sacrifice network size with Anthem’s plans. If you elect an Anthem policy, you have SSM and Mercy hospitals “in-network”. Barnes and Saint Lukes’ are out of network. You do not need to pick a primary care physician or get referrals with Anthem’s plans. If lowest deductibles and out of pocket expenses (like prescription co pays) are your biggest concern, Anthem is a good fit.
Coventry’s options are broken down into two separate offerings: Carelink and CoventryOne PPO. These two plans are structured the same (ie same co pay and same deductible) but they have a major difference in networks.
- Coventry’s Carelink – Any option you see with this designation will use SSM and Mercy “in-network”. Barnes and Saint Luke’s are considered out of network. You also need to elect a primary care physician and get a referral from them to see a specialist. For many younger people, this is a foreign concept as they often don’t even have a primary care doctor at present. Of all the options offered in the Saint Louis area, Coventry’s Carelink tends to be the lowest premium. If premium is your biggest concern, this is the best bet for your budget.
- Coventry PPO – Any option you see with this designation will have the broadest network of any Obamacare plan offered. This plan has SSM, Mercy, St. Luke’s, and BJC all in-network. If you desire a comprehensive network and have established doctors and wish to keep them, this plan is where you should look. Of all the options available, this one most resembles pre ACA plans. However, it does come with the highest monthly premium.
Here is an example: 55 female in Saint Charles County. Silver level plans.
|Company||Premium||Deductible||Out of pocket Max||Co pay at doctor|
|Anthem||$459.60||$3,000||$3,600||subject to deductible|
Hopefully this provides some clarity to the process. If you would like our personal, free one-on-one assistance, please contact Karl at 636-561-5060.