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Sharp Health News

Confused about health insurance?

Oct. 9, 2018

Confused about health insurance?

Open enrollment is the time of year when you can make changes to or buy health insurance for you and your family — whether you're Medicare eligible, covered through your employer or purchasing a health plan directly through a health insurer like Sharp Health Plan, a broker or the Covered California health insurance exchange. (Note: not all employees have open enrollment at the same time. Check with your employer for open enrollment dates.)

Don Truong, director of sales for Sharp Health Plan, answers some of the most common questions consumers have about choosing health insurance.

How do I enroll in health insurance?
If you get health coverage through your employer, check to see if your employer is offering different health plans for the upcoming year. If you and your spouse have access to different plans through your employers, compare them to see which plan will best meet your needs. It is also a good idea to contact your human resources department to make sure they have everything they need to get you covered in the right health plan for next year.

If you are self-employed or a student, or want to enroll in a plan that isn't offered through your employer during open enrollment, you may be able to enroll directly with the health insurance carrier of your choice. Most health plans offer an online tool on their website for consumers to get quotes, compare plans and enroll in just a few minutes.

For individuals and families who need more affordable health coverage, or if you want to see if you qualify for financial assistance, Covered California can be a helpful place to start.

What should I consider when choosing a health plan?
First and foremost, you should look at the quality of the health plan. Covered California has a five-star rating system with five stars as the top rating. Covered California also allows you to compare your plan options with their "Shop and Compare" tool.

You might also be interested in the annual health insurance plan ratings published by the National Committee for Quality Assurance (NCQA). Every year, the NCQA rates health plans on a scale of zero to five (where five is the highest rating) based on clinical quality, member satisfaction and NCQA accreditation survey results.

Platinum, Gold, Silver, Bronze — what do these categories mean?
Health plans fall under four categories, or metal tiers: Platinum, Gold, Silver and Bronze. If you see a doctor more often, then a Platinum or Gold plan will likely be best for you because they have lower costs when accessing care. If you are healthy and do not visit the doctor too often, a Silver or Bronze plan may be best because they carry lower monthly premiums but higher out-of-pocket costs when accessing care.

Terms to know
To compare costs across categories, here are the terms you need to know:

  • Deductible: The amount you owe for health care services before your health plan starts to pay
  • Premium: The amount you pay for your health insurance every month
  • Copay: A fixed amount you pay for a covered health care service

Comparing health plans by tier
Remember, the difference between the plan designs is in the member's share of cost — not in the health care services covered.

Bronze Tier

Deductible: Can be thousands of dollars a year
Premium: Lowest of all tiers
Copay: Highest of all tiers
Consider enrolling in a plan under this tier if: You want a low-cost way to protect yourself from worst-case health situations such as serious illness. Your monthly bill will be low, but you will need to pay upfront for most health care services.

Silver Tier

Deductible: Usually lesser amounts than Bronze plans*
Premium: Moderate
Copay: Moderate
Consider enrolling in a plan under this tier if: You are willing to pay a slightly higher monthly bill than Bronze to ensure more of your routine health care services are covered.

Gold Tier

Deductible: Usually low*
Premium: High
Copay: Low
Consider enrolling in a plan under this tier if: You are willing to pay more every month to have more costs cover when you get care.

Platinum Tier

Deductible: Very low*
Premium: Highest
Copay: Lowest
Consider enrolling in a plan under this tier if: You access care often and are willing to pay a high monthly premium. Nearly all other costs for your health care services will be covered.

*Not every Silver, Gold or Platinum plan has a deductible.

Are there any free resources that can help me decide which plan is right for me?
Yes! Sharp Health Plan hosts free health insurance seminars during open enrollment season. Experts will be available to explain how health insurance works and help you find the right health plan for your needs.

Open enrollment typically runs between October and December each year. For questions, call 1-800-82-SHARP (1-800-827-4277).

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