in Waltham, Massachusetts
Shopping for insurance can easily become confusing and overwhelming, there are many different types of policies to choose from and it can be difficult to compare apples to apples. But buying health insurance doesn't have to be difficult. American Health Insurance can quickly connect you with the most comprehensive and affordable plans available in your area.
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BEST HEALTH INSURANCE PLANS
Health insurance is essential to help make medical expenditures affordable. American Health Insurance helps residents of Waltham, Massachusetts understand their options and get the right plan at the right price.
We know that deciding on an insurance plan can get confusing. Do you need an ACA or non-ACA plan? What's the difference between the metal tiers? These are just some of the questions you may have about your insurance options. Call today, we can connect you with local insurance agents who can answer all your questions and make it easy to find the perfect health insurance policy to fit your needs.
In order to break through all the confusion, we will explore and compare the best Waltham, Massachusetts 2022 health insurance plans so that you can make the right decision concerning your and your family's current and future wellbeing.
COMPARE Waltham, Massachusetts
HEALTH INSURANCE OPTIONS
So, how can you compare Waltham, Massachusetts health plan options? The easiest way is by exploring the tiers that plans come in and looking at the type of networks they belong to. In this section, we will examine only Affordable Care Act (ACA) insurance options that can be found on your local Health Insurance Marketplace. Non-ACA plans will be explored in a section below.
An ACA plan refers to a health insurance policy that follows the standards and regulations that are outlined in the Patient Protection and Affordable Care Act (PPACA). As the name suggests, its purpose is to make healthcare more affordable and ultimately, to protect patients.
On the Health Insurance Marketplace, a Waltham, Massachusetts health plan will fall into one of four metal tiers. Basically, the different metal tiers are based on how you'll share costs with your insurer. It's important to note that while the tiers may be different, the quality of care that you'll receive remains the same across all tiers. Each tier is broken down as follows:
- Platinum: Insurer pays 90% and you pay 10%. Highest monthly premiums with the lowest deductibles (the point at which insurance starts to pay) and the lowest costs when you need medical care. It's a good choice if you want to get the most amount of cover and don't mind paying a higher monthly amount.
- Gold: Insurer pays 80% and you pay 20%. You can expect high monthly premiums together with low deductibles and cost of care when you need it. This tier is a good choice if you expect to need regular cover at the cost of a higher premium.
- Silver: Insurer pays 70% and you pay 30%. With the Silver tier, you can expect moderate monthly premiums combined with moderate deductibles and cost of medical care. It's a good choice if you want lower monthly premiums but with less coverage for routine care. The Silver plan is also the only tier eligible for cost sharing reductions (CSR), sometimes referred to as "extra savings". Requirements are based on your household income relative to the federal poverty level.
- Bronze: Insurer pays 60% and you pay 40%. The Bronze tier offers the lowest monthly premiums, but you can expect to have high deductibles and health care costs. It's a good choice if you want to have cover for serious injury or sickness but you can expect to pay most of the cost of regular medical care.
The Marketplace also has a range of network types. Insurers negotiate with Waltham, Massachusetts healthcare providers, creating a network of care that generally encompasses all your healthcare needs. This allows you to benefit from the discounts that the network offers. Going out-of-network, depending on the plan, may leave you paying for more or all of your medical bills without aid from the insurer.
The types of network plans available for ACA health insurance policies include the following:
- Point of Service (POS) Plan: With a POS health plan, you will be covered with both in- and out-of-network services. You can choose a primary care physician (PCP) from a list of providers in the network and if you need a specialist, your PCP will need to refer you. If you want to go out-of-network, then you'll need a referral from your PCP to be covered; however, out-of-pocket expenses will be higher.
- Exclusive Provider Organization (EPO): EPOs usually restrict coverage to providers within the network, unless it's an emergency.
- Preferred Provider Organization (PPO): With a PPO health plan, both in- and out-of-network care is covered. Going out-of-network for health care will cost more but you don't need a referral from your PCP to be covered.
- Health Maintenance Organization (HMO): In an HMO plan, going out-of-network will result in limited or no coverage, except in emergency situations. HMO plans usually require that you choose a PCP from the list of providers in the network, and you'll need a referral if you need to see a specialist.
With all plans, you can expect to be covered while using out-of-network medical care if it is an emergency.
How to Choose the Right
Waltham, Massachusetts Plan
Choosing the right Waltham, Massachusetts health plan for your needs can make a significant difference in both catering to your medical needs and your bank account. Even if you're happy with your current plan, it can be worthwhile to check on the new plans available to you because there are often changes to cost structures or new competitors that can cause prices on existing plans to drop.
There are several things that you should carefully consider if you are looking to change your current Waltham, Massachusetts plan or in choosing your first health insurance policy. Some of the factors that you must consider include the following:
- Your preferred doctor: Health insurance plans such as HMOs require that you choose a primary doctor. If you have a family doctor that you'd like to keep, then you will need to check that they are part of the insurer's network that you are considering.
- Current medical needs: This is an important factor because if you require frequent medical care, then choosing a plan with low premiums might not be the best choice because of the high cost of care, such as with a Bronze or Silver plan. Conversely, if you rarely need medical care, then choosing a Gold or Platinum package with high premiums might be a waste. Examine your past year's medical needs as a benchmark - you may find that you were well below your limits which may mean that you'll be better off with a lower tier plan.
- Future medical needs: Your future medical needs should also be considered. If, for example, you are having a baby in the near future, then your medical care needs will change and so too should your health plan.
- Prescription drug coverage: If you require specific prescription drugs, then you will want it to be covered. Check the details of the plan to ensure that you are adequately covered for your medication.
- Premium Tax Credits: If you are eligible for premium tax credits, then you may be able to afford a plan that you weren't able to before. Generally speaking, if your household earns between 1 to 4 times the federal poverty level relative to your household size, then you may be eligible. The amount you can save increases the lower your household income is.
- Dental and vision insurance: Dental and vision insurance often needs to be purchased separately and if you require these services, then that should be factored into the overall amount you are willing to spend.
- The impact of unforeseen medical needs: While it may seem like a good idea to choose a health insurance policy with the lowest premiums if you are healthy, you should consider what will happen in the event of a significant unexpected medical situation. If a medical emergency could put your financial stability at risk, then paying a higher monthly premium for greater coverage may be the better option.
ACA health plans on the Health Insurance Marketplace are designed with every type of person in mind. By exploring your options and taking a close look at your current and potential future needs, you can find a perfect plan to suit your needs.
Individual Health Insurance Plans
Individual health insurance is available to residents of Waltham, Massachusetts through the Health Insurance Marketplace as well as non-ACA options. Non-ACA plans are discussed below. Having individual insurance is important to ensure that you are covered for unforeseen and expected medical needs.
As an individual, if you are healthy and do not require frequent medical services, then you might want to consider a Bronze or Silver tier plan as it will help to reduce the monthly payments that you have to make. If you have pre-existing conditions that you want to have covered, then an ACA policy is your best option because most non-ACA plans do not cover pre-existing conditions.
Waltham, Massachusetts Families
Family health insurance can be a great way to combine your whole family's health insurance needs into one package. There's no need to pay several premiums and combining your whole family into one health insurance policy is often cheaper than buying each member their own health plan.
Choosing the right Waltham, Massachusetts plan for your family takes careful consideration. You are not just getting health insurance for one person; the medical needs of an entire family can be exponentially greater than the needs of an individual over the course of a year. It is therefore important that you consider your financial situation with the current and future health needs of your family.
A low-premium plan such as a Bronze plan can seem financially attractive but if, for example, the whole family comes down with the flu, it can put a strain on your finances if your deductibles, out-of-pocket expenses, and copayments are high.
Children may also require considerable medical care, such as dental work and regular checkups. When all of the factors of insuring your family are put together, it often makes more financial sense to choose a plan that is better able to accommodate unexcepted and expected medical expenditures.
The family health plans available in Waltham, Massachusetts include both ACA and non-ACA options. If you are eligible for cost sharing reductions (CSRs) or premium tax credits based on your household income, then it can help to make family insurance more affordable. Furthermore, the Children's Health Insurance Program (CHIP) can help to reduce insurance cost if your household is eligible.
Group Health Insurance Policies
Group health plans refer to insurance that is gained through employers. It can cover an individual employee as well as their family. Waltham, Massachusetts group health insurance can also be bought as an organization of members.
Group health insurance policies are generally more affordable than individual or family insurance because the risk that the insurer takes is spread out across the members of the group. Furthermore, premiums can be paid with pretax dollars, which essentially means that as an employee with group insurance through your work, you will have to pay less in annual taxes. Payroll taxes for employers are also lower, so when it comes to their annual contributions, they end up paying less income taxes.
The types of plans, costs, and the exact terms and conditions of each group insurance plan is usually specific to that group - one group plan may have significant differences to another. If a group insurance policy is offered to you, you may choose to reject it in favor of your own insurance. The group insurance policy may also offer members the various metal tiers so that each member is able to choose a plan that best suits their needs.
Health Savings Account Plans
A Waltham Health Savings Account (HSA) plan is similar to a savings accounts except it can only be used for eligible healthcare services and expenses. It is a way to save money for future medical expenses and has several benefits to consider.
HSA plans are only available to people with High-Deductible Health Plans (HDHPs). Generally speaking, HDHPs are used by healthy, younger people because the plan has high deductibles - the minimum amount that you need to pay for medical services before your insurer starts to pay. HDHPs have lower premiums as a result of the higher costs involved with receiving care. HDHPs are also preferred by high income households who can afford higher deductibles because of the tax benefits that HSA plans have.
HSA plans have several benefits including the following:
- Anyone can contribute: Anyone from your employer to relatives, including you, can contribute to your HSA. However, there are limits imposed by the Internal Revenue Service (IRS).
- Wide range of expenses: An HSA can be used for a wide range of medical expenses, making it flexible.
- Pre-tax contributions: The contributions made into your HSA are usually done with pre-tax dollars, which means that it isn't included in your gross income for federal tax purposes. Any contributions made after tax can also reduce your tax amount for the year.
- Tax-free earnings and withdrawals: HSAs can earn tax-free interest, and withdrawals are not subject to federal and state taxes in most cases.
- Rollover: If at the end of the year you have money left in your HSA, then it will roll over to the next year.
- Ease of use: Many HSA plans will provide you with a debit card linked directly to your HSA so that it can be used to pay for medical expenses directly.
While an HDHP can be more costly than other health insurance policies, the benefits of an HSA can outweigh the added costs involved while still ensuring that significant medical expenses are better covered.
Short-Term Health Insurance
If you are in need of Waltham, Massachusetts health insurance for a relatively short period, such as during a period of unemployment before getting health benefits at a new job, then short-term health insurance can be an ideal choice. However, Waltham short-term health plans are not qualified under the Affordable Care Act. What this means is that this type of insurance doesn't have to adhere to the same rules as the health insurance policies found on the Marketplace.
While short-term insurance does not offer the same level of coverage that you can expect from an ACA plan, it does have various advantages. Short-term insurance is a good solution for someone who doesn't want the added costs of ACA plans because they don't need all of the usual cover. For example, a healthy, young person may want to use short-term insurance as a temporary insurance solution, knowing that their general healthcare needs are minimal. However, most plans only last for around 3 months with the possibility for renewal. They can usually be extended up to 12 months depending on your state.
It is also a good solution if one of the following applies to you:
- You are waiting for your main insurance plan coverage to begin.
- It can be an insurance option if you are waiting for Medicare coverage to start.
- You missed the Open Enrollment period (the annual period where ACA plans may be purchased) and need coverage in the interim.
Short-term plans don't cover pre-existing conditions and other benefits that are covered by ACA plans such as childbirth, mental healthcare, and preventative care.
Health Insurance Enrollment
in Waltham, Massachusetts
The Health Insurance Open Enrollment period is an end-of-year period when you can purchase an ACA healthcare plan from your local Waltham Health Insurance Marketplace. It is generally open for a few weeks between November and December.
Even though you may be satisfied with your current health plan, it is advised that you review the offers available in Waltham, Massachusetts every year. You may find a better suited deal or something a bit more affordable with the same level of coverage as you currently have.
If you missed the Open Enrollment Period and need insurance, then you may:
- See if you qualify for the Special Enrollment Period: Various things can qualify you such as getting divorced, getting married, a death of someone in your health plan, had a baby, and more.
- Purchase insurance through a broker or agent: This can be done at any time of the year. The broker or agent can help you to choose a non-ACA plan such as short-term insurance.
- Purchase insurance from an insurance provider: Alternatively, you can go directly to an insurance provider and browse their non-ACA plans.
Under the Affordable Care Act, plans on the Marketplace must provide essential benefits. These benefits include most common and emergency services that one would expect from a comprehensive Waltham, Massachusetts insurance plan.
The 10 essential benefits that are offered by health plans on the Marketplace include:
- Emergency services
- Care for pregnant women, newborn care, and maternity
- Care you receive outside of hospital admission such as ambulatory services
- Prescription drugs
- Rehabilitative services, including devices
- Laboratory services
- Pediatric services such as vision and dental care (for children)
- Chronic disease management and preventative services
- Care for substance use disorder and mental health
While essential benefits are required for plans to be sold on the Marketplace, some plans may offer additional services such as vision and dental coverage.
The Health Insurance
The Health Insurance Marketplace, also known as "exchange", is where you will find all of the health insurance policies that fall under the Affordable Care Act available in Waltham, Massachusetts.
In most states, the federal government will be in charge of the Marketplace, but some states may run a Marketplace of their own. Agents can help you easily enroll in a Marketplace plan.
Non-ACA Plans for Residents
of Waltham, Massachusetts
Non-ACA health plans encompass all insurance options that are not sold on the Marketplace. This means that these plans do not need to follow the same guidelines as the plans found on the Marketplace. While the ACA is meant to make healthcare more affordable, it can be cheaper for a healthy person to get a non-ACA health insurance policy if no significant unexpected medical events occur.
There are many non-ACA plans available, and the plans can vary greatly from one insurance provider to the next. Short-term insurance, as discussed above, is one of the common non-ACA plans. Some of the other common non-ACA policies available in Waltham, Massachusetts include the following:
- Critical Illness and Accident Insurance: This type of plan is aimed at covering severe and unexpected medical situations such as vehicle accidents, illness, or injury. There is usually no cover for regular checkups and care.
- Limited Benefit Indemnity Insurance: With this non-ACA plan, you are covered at a fixed rate for each of your medical service needs. It tends to be limited in the type of care that it covers, such as limited or no cover for inpatient care. There are also usually no annual deductibles.
Health policies outside of the Marketplace serve a purpose and many people prefer it over ACA plans because it covers their minor medical needs while being more affordable. It may also be a way to stay insured while between major insurance plans (ACA plans).
Health Insurance FAQs
Residents of Waltham often have questions they need answered before making a decision on health insurance. To help you better understand your options, here are answers to a few frequently asked questions:
A health insurance policy can protect you and your loved ones from unforeseen medical problems while making everyday medical expenses more affordable. Call us today to explore your options. Agents are standing by make it easy for you to find a plan that is perfect for your needs.
Find Coverage for Your Whole Family
in Waltham, Massachusetts
If you're looking for coverage for your family in Waltham, Massachusetts, American Health Insurance will connect you with top insurance providers who can help you compare options to suit the needs of everyone in your household.
As you shop for a plan for your family, you will want a plan that provides the options to see a variety of different doctors and specialists. If you have, or plan to have, children you will want to make sure that you have a plan that covers every aspect of pregnancy as well as pediatric care. As you grow older your health insurance needs tend to increase.
If you are struggling with health issues now that could potentially get worse in the coming years, you want to double-check and see what Waltham specialists are covered by your plan.
Protect your family's health.