Understanding Your Individual and Family Plan Options

As Open Enrollment approaches, it's a great time to review your health coverage and decide whether your current plan still meets your needs. If your health, prescription, provider, or budget needs have changed over the past year, consider exploring the plans available in your area. Shop and compare plans at marketplace.viabenefits.com between November1and December 15.

Via Benefits works with a variety of insurance carriers, including both well-established and newer health plans.

Reviewing Plan Options

Essential benefits ‍
Covers preventive, emergency, outpatient, mental health, and prescriptions.
Provider network ‍
Use in-network providers for coverage; most plans won't cover out-of-network services, except emergencies.  
Cost and premiums
Compare the monthly premium with what you may pay when you receive care, including deductibles, copayments, coinsurance, and the out-of-pocket maximum.
Deductible  
The amount you pay for certain covered services before the plan begins paying its share. Some services may be covered before you meet the deductible.
Cost sharing  ‍
After you've met your deductible, you'll likely be required to pay a portion of the cost of service through coinsurance or copays.

Types of Plans

Marketplace plans
Marketplace Plans are offered through federal or state health insurance marketplaces.

If you want to receive a federal Premium Tax Credit (PTC) or Cost-Sharing Reduction (CSR), you must enroll in a Marketplace plan.

Private plans
Private Plans are Individual and Family Plans purchased directly from an insurance carrier through Via Benefits.

Private Plans may be available in some areas and can sometimes offer lower premiums than comparable Marketplace plans. They generally provide the same essential health benefits required by the Affordable Care Act, although provider networks, prescription drug coverage, and out-of-pocket costs may differ.

A licensed Via Benefits advisor can help you determine which type of plan best fits your needs and budget.

Metal Tier Categories

There are four Individual and Family Plan categories, aka the “metal tiers” — Platinum, Gold, Silver, and Bronze. Health plan metal tiers classify insurance by coverage and costs.

Which metal tier is right for you? Via Benefits can help you decide.

Types of Health Plan Networks

Within these plan level categories, you may have several plan types to choose from. The majority of plans available to you will likely be Health Maintenance Organizations (HMOs). Preferred Provider Organizations (PPOs) are also available, though PPOs are not available in all areas.

Typically, HMOs are more affordable than PPOs, though they offer a less extensive network. PPOs tend to provide a broader network than HMOs and the flexibility to see any healthcare provider in their network.

Your choice depends on your preference for cost, provider access, and care coordination.

Snowbirds, Take Note

If you live in more than one place during the year or travel frequently, keep the following in mind:

Your plan will cover care at in-network rates for true emergencies regardless of where you are located.
For non-emergency care, an HMO with a narrow network of providers may not cover you in all the places you travel.
If available, a PPO might be your right option because you can see out-of-network providers.
Look for a plan in the region where your primary providers are located.
You may be able to use your regular providers' telehealth options while traveling.