In recognition of Wise Health Consumer Month – which began Feb. 1 − Health Net, Inc. (NYSE: HNT) is offering helpful tips to those shopping for health coverage.

“Individuals are able to sign up for health insurance in the federal and state exchanges – also known as the Health Insurance Marketplace – through March 31, so this is a good time for many people to look at their options and make decisions,” said Steve Sell, president of Health Net, Inc.’s Western Region Health Plan. “Health Net is committed to helping individuals and families pick the plan that best meets their needs.”

Words Worth Knowing

Before comparing coverage options, it’s best to first refresh your health insurance vocabulary. Be familiar with the meaning of these words, as defined on www.HealthCare.gov:
  • Premium – the amount of money that must be paid to your insurance carrier. You and/or your employer usually pay the premium monthly, quarterly or annually.
  • Coinsurance – your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance, plus any deductibles that you may owe. For example, if the insurance carrier’s allowed amount for an office visit is $100, and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. The insurance carrier pays the rest of the allowed amount.
  • Copayments (or copays) – a fixed amount (for example, $15) that you pay for a covered health care service, usually when you receive the service.
  • Deductible – the amount you owe for health care services before your insurance carrier begins to pay. For example, if your deductible is $1,000, your plan won’t pay for anything until you’ve met your $1,000 deductible for covered health care services that are subject to the deductible.

Health Insurance Marketplace Plans – Four Categories

Insurance plans available through www.HealthCare.gov – or through one of the state health insurance exchanges, such as www.coveredca.com – are divided into four categories: bronze, silver, gold and platinum.

All of the plans offer essential health benefits, including: emergency services; hospitalization; laboratory tests; maternity and newborn care; mental health and substance abuse treatment; outpatient care; pediatric services (including dental and vision care); prescription drugs; preventive services (such as immunizations and mammograms) as well as management of chronic diseases (such as diabetes); and rehabilitation services.

What distinguishes the four categories from each other are their associated premium costs and the portion of charges that you must pay for things like hospital stays or prescription medications. The category selected also affects your total, annual out-of-pocket costs. The maximum annual out-of-pocket costs for any 2014 Qualified Health Plan are $6,350 for an individual plan and $12,700 for a family plan.

To better understand the differences between categories, www.HealthCare.gov offers these guidelines:
  • Platinum and gold plans pay more of your out-of-pocket costs when you receive care and usually have higher premiums. If you anticipate the need for numerous doctor visits and other services, your best choice may be a platinum or gold plan.
  • With silver and bronze plans, you’ll likely pay a lower premium, but you’ll pay a higher share of the costs when you receive care. If you don’t expect to need frequent doctor visits or other ongoing health care services, a silver or bronze plan may work for you. However, if you experience an unexpected health problem or are involved in a serious accident, a silver or bronze plan may require you to cover more of your health care costs.

Tailored Networks

Even within the same category, different types of plans are available. “For example,” said Sell, “at Health Net, we’ve focused on developing high-value networks of health care providers in certain areas that offer consumers lower premiums. As a result, Health Net’s CommunityCare HMO in the silver level has the lowest premiums in five California counties – Los Angeles, Orange, Riverside, San Bernardino and San Diego. In fact, our silver plan premiums can be less than many bronze plans available in the marketplace.”

Cost Reductions Available

Individuals and families may qualify to pay lower premiums for their coverage purchased on the federal or state health insurance exchanges. These reductions are based on income and family size. In general, if your income falls within the ranges below, you'll qualify to save money on your premiums for plans purchased on the exchanges in 2014. The lower your income within these ranges, the more you'll save:
  • $11,490 to $45,960 for individuals
  • $15,510 to $62,040 for a family of two
  • $19,530 to $78,120 for a family of three
  • $23,550 to $94,200 for a family of four
  • $27,570 to $110,280 for a family of five
  • $31,590 to $126,360 for a family of six
  • $35,610 to $142,440 for a family of seven
  • $39,630 to $158,520 for a family of eight

In addition to premium credits, the Affordable Care Act also offers people – with incomes up to 250 percent of the federal poverty level – cost sharing subsidies for help paying things like deductibles, copayments and coinsurance. These reductions can be an important consideration for lower-income consumers when choosing their coverage. Cost sharing reductions will be applied automatically for consumers who qualify based on their income but only if they buy a silver level plan, considered the benchmark under the health care reform law.

Coverage Options Available Outside the Marketplace

“Health Net continues to offer affordable quality health coverage outside the federal and state exchanges as well,” said Sell. “Consumers should contact their broker or a broker who sells health insurance to learn more.”

Medical Advice Disclaimer

The information provided is not intended as medical advice or as a substitute for professional medical care. Always seek the advice of your physician or other health provider for any questions you may have regarding your medical condition and follow your health care provider’s instructions.

About Health Net

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net provides and administers health benefits to approximately 5.3 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Through its subsidiaries, Health Net also offers behavioral health, substance abuse and employee assistance programs, managed health care products related to prescription drugs, managed health care product coordination for multi-region employers, and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit Health Net’s website at www.healthnet.com.

This release contains links to other sites that are not owned or controlled by Health Net. Please be aware that Health Net is not responsible for the contents linked or referred to from this release. Links to other websites are provided for the user’s convenience. Health Net does not express an opinion on the content or the properties of such linked websites and disclaims any liability in connection therewith.

Copyright Business Wire 2010