What’s the Best Health Insurance Option for You?

Originally published on

Despite efforts to improve the health plan-buying process, choosing health insurance isn’t like buying a car. Deciding between car accessories can be fun. Picking a health insurance plan can feel like a chore, but it’s one of the most decisions you make each year.

You might feel confused about health insurance terms and the myriad options available to you. You may feel like you’re not even sure where to start. We’re here to help.

On this page, we’ll go through possible avenues for health insurance coverage depending on your situation. Not all of these solutions may work for your specific case. Instead, it’s a guide of what’s likely a choice for you.

Now, before we get into options, let’s talk about what you should compare when choosing a health insurance plan:

  • Your finances. How much money do you have for out-of-pocket costs? Are you eligible for health insurance tax credits?
  • Family situation. Do you need a family health plan?
  • Health care need. What are your and your dependents’ health care needs?
  • Job status. Are you employed?
  • Location. What individual plans are offered in your state?
  • Your health plan preferences. Would you rather a restricted network of providers at a lower cost or more flexibility with higher premiums?

All of those factors play a part on what health insurance would work for you.


Open enrollment

Open enrollment is when most Americans sign up for or change health insurance. That period varies by how you get insurance.

Here’s when open enrollment is for different types of insurance:

  • Employer-sponsored health insurance: Businesses don’t have a uniform open enrollment period. Instead, each company picks a time for employees to make benefit changes. Ask your benefits department when open enrollment is for you.
  • MedicareMedicare open enrollment runs from Oct. 15 to Dec. 7. Beneficiaries can sign up for or change a Medicare plan.
  • Individual insurance/Affordable Care Act (ACA) exchange plans: Open enrollment is from Nov. 1 to Dec. 15 for most Americans. There are a handful of states that have longer open enrollment for the individual market. We’ll get more into that later.
  • Medicaid and Children’s Health Insurance Plans (CHIP): There is no open enrollment for Medicaid and CHIP. You can sign up at any time of the year if you’re eligible.

You can only make changes to your health insurance during open enrollment unless you have a qualifying event that kicks off a special enrollment period. This could be because of a job loss, reduced hours, a death, a divorce or a new child.


What health insurance is available for you?

Now, let’s go through 10 scenarios and likely health insurance options for you.

People with a job that offers health insurance

Having a job makes it much easier to get health insurance. Most Americans are covered through their job. Employer-sponsored coverage is usually cheaper than an individual plan. That said, there are other options even if you’re employed.

Here are five options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer


Individual market/Affordable Care Act exchanges

Short-term health plans


Someone with a spouse whose employer offers health insurance

Going with an employer-sponsored health plan is usually your best bet. Employers share the costs with employees. That results in lower premiums and out-of-pocket costs.

Don’t forget to explore your spouse’s employer’s insurance options.

Here are five options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer


Individual market/Affordable Care Act exchanges

Short-term health plans


Someone who’s unemployed

Not having a job is tough enough. It also means you lose an option of getting health insurance through your employer.

Your options were once more limited when you lost your job. In fact, COBRA might have been your only option. However, the ACA and recent Trump administration regulation changes give you more choices if you’re unemployed.

Here are six options (click on any plan to find out more):

Health insurance through your spouse’s employer



Individual market/Affordable Care Act exchanges

Short-term health plans

Children’s Health Insurance Program


Senior citizen

Turning 65 is a health insurance milestone. You become eligible for Medicare and can choose between original Medicare or Medicare Advantage.

You don’t have to sign up for Medicare at 65 years old, but it’s a wise choice. If you wait, you could get fined when you sign up. Not enrolling in Part B can also mean a 10 percent premium late-enrollment penalty for each year you don’t sign up.

One option is to get Medicare Part A (hospitalizations), which is free for most Americans, and keep your employer plan if you’re still employed. Make sure you take into account the possible late-enrollment penalty if you don’t sign up for Part B when you become eligible for Medicare.

Here are four options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer

Original Medicare

Medicare Advantage


Young adults/20-somethings

The ACA requires insurers allow members to keep their children on health plans until the child turns 26. The good news is there are multiple options for young adults and 20-somethings other than your parents’ insurance.

If you find regular health insurance plans are too pricey, you can explore a short-term health plan. These plans have low premiums but don’t offer the same protections as a regular health insurance plan. So, beware of the limited coverage and out-of-pocket costs associated with those plans.

Here are four options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer

Individual market/Affordable Care Act exchanges

Short-term health plans


Someone who’s middle class

Your family’s household income can play a part in your health insurance options.

The IRS provides premium tax credits for households with incomes between 100 percent and 400 percent of the federal poverty line.

Federal poverty level guidelines

Persons in Household Federal poverty level for continental U.S. Premium subsidy threshold (400% of federal poverty level)
1 $12,140 $48,560
2 $16,460 $65,840
3 $20,780 $83,120
4 $25,100 $100,400
5 $29,420 $117,680
6 $33,740 $134,960
7 $38,060 $152,240
8 $42,380 $169,520

Of course, you also may have the option of a plan through your job or your spouse’s job, which is likely a more affordable option than going with an individual or ACA plan even with tax credits.

Here are four options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer

Individual market/Affordable Care Act exchanges

Short-term health plans


Someone with a lower income

Americans will lower incomes have the potential for more help with their health insurance. The IRS offers premium tax credits and the ACA also kicks in funding to help offset out-of-pocket costs for lower-middle-class Americans with incomes less than 250 percent of the federal poverty level.

There’s also a public program option like Medicaid and the Children’s Health Insurance Program. States’ eligible income levels vary for Medicaid and CHIP. We’ll get more into that later.

Here are six options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer


Individual market/Affordable Care Act exchanges

Short-term health plans

Children’s Health Insurance Program


People with children

Getting your children covered is probably even more vital in your mind than getting insurance for yourself. Medicaid covers more than 45 million children and CHIP provides include for about 9 million.

Here are five options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer


Individual market/Affordable Care Act exchanges

Children’s Health Insurance Program


Someone with pre-existing conditions

Searching for affordable health insurance when you have a pre-existing condition, such as diabetes or heart disease, was once nearly impossible. Before the ACA, insurers could reject people with pre-existing conditions if they applied for an individual health plan. Alternatively, those insurers might charge high premiums because of the added risk.

The ACA ended that practice. Now, Americans with pre-existing conditions can’t get denied coverage and won’t pay a lot more for health insurance.

Here are four options (click on any plan to find out more):

Health insurance through your employer

Health insurance through your spouse’s employer


Individual market/Affordable Care Act exchanges


Small business owner or contractor

Being a small business owner or a contractor can limit your insurance options and you may face significant health coverage costs.

However, there are more options for small business owners and contractors in 2019. The Trump administration changed regulations that will expand short-term plan and association health plan options.

These low-cost options come with fewer consumer and patient protections. So, you want to decide if sacrificing regular health insurance plan benefits are worth the lower costs.

Here are three options (click on any plan to find out more):

Individual market/Affordable Care Act exchanges

Short-term health plans

Association health plans


Your options for health insurance

Health insurance isn’t one-size-fits all. Your options vary depending on your job status, age, income, family and what you want from your insurance. In other words, would you rather pay more for premiums and less out-of-pocket? Alternatively, do you want low premiums with the potential for substantial out-of-pocket costs?

Here are 10 health insurance options and descriptions about each one.


Health insurance through your employer

Employer-sponsored health insurance remains how more than half of Americans get their coverage. This coverage is also cheaper than many non-government options. That’s because your employer is chipping in to pay for health insurance.

Annual family premiums for employer-sponsored health insurance plans averaged $19,616 in 2018. Employees contributed $5,547 on average for those premiums. Single coverage averaged $6,896 with workers contributing an average of $1,186 annually, according to Kaiser Family Foundation.

Pros: Cheaper than the individual market.

Cons: Limited choices, employer must offer coverage.


Health insurance through your spouse’s employer

Most businesses allow employees to add their spouse and children to health plans, but it comes at a cost.

Some employers have removed the spouse tier for health insurance. In those cases, employees only have an individual or family plan option. That can result in higher premiums for a couple without children because they’re paying for family coverage.

When both you and your spouse have health insurance options, it’s a good idea to compare plans. You could actually save more than $1,000 each year depending on the health plan.

Where do you start? Compare the plans’ out-out-pocket costs, deductibles, copays and coinsurance. You might find your spouse’s plan makes more sense for your family. Just remember to check that your providers are part of that plan’s network.

Pros: Cheaper than the individual market.

Cons: Limited choices, employer must offer coverage.



If you lose your job, you are likely eligible for COBRA coverage for 18 months.

You must sign up by 60 days after the qualifying event, such as getting laid off. COBRA extends your employer-sponsored plan though you’re no longer employed. COBRA is costly since the employer no longer pays for your coverage. You pay as much of 102 percent of the costs of the plan.

The average annual family premiums for an employer-sponsored health insurance plan cost nearly $20,000 in 2018. Employees contributed about $5,500 on average. So, if you have a COBRA plan in this scenario, you’d wind up paying more than $20,000 in premiums. That’s pricey but allows you to maintain your coverage temporarily.

Pros: Allows you to keep your previous employer’s plan.

Cons: Costly, only available for 18 months after employment.


Original Medicare

Medicare Parts A & B are often called original Medicare. It’s the program that has covered seniors since the 1960s.

Part A covers hospitalizations; Part B deals with physicians and outpatient care. Nearly all seniors can sign up for Part A without any premiums when they turn 65.

Annual Part B premiums average $1,600 in 2019, but that could be higher depending on your income.

Pros: Accepted by most physicians and hospitals, Part A doesn’t charge premiums for most people, Part B can be a better alternative than employer plans or individual insurance.

Cons: You may have trouble finding a physician that accepts Medicare, you’ll need to get a Part D prescription plan and Part B coverage can be more expensive than Medicare Advantage.


Medicare Advantage

Medicare Advantage is a plan that’s offered by a private insurance company. It’s an alternative to original Medicare.

Many Medicare Advantage plans have prescription drug benefits. The plans also have supplemental benefits, such as home health care, transportation to appointments and population health initiatives.

The average annual Medicare Advantage premium for 2019 is $336, though nearly half of enrollees have a plan with no premiums.

Pros: Less expensive than employer-sponsored plans.

Cons: You might have trouble finding a Medicare Advantage plan that accepts doctors in your area if you live a rural region.



Once viewed as a safety-net health insurance program that covered the poorest people, Medicaid has grown into an even more substantial way Americans get health insurance.

Medicaid, which is a federal/state program, covers nearly 70 million Americans. The ACA allowed states to expand Medicaid. What this did was let people up to 138 percent of the federal poverty level get coverage.

Three dozen states expanded Medicaid. Other states are also showing interest in the possibility, which is the primary reason why 15 million more Americans have health insurance since the ACA.

The costs of a Medicaid plan varies depending on your state and income. That said, Medicaid costs are much cheaper than most plans.

Pros: Low-cost plans that provide all the coverage found in regular health insurance.

Cons: Not all doctors accept Medicaid.


Individual market/Affordable Care exchange plans

The individual market could be an expensive option for uninsured Americans before the ACA. The health law made the market more affordable — though it’s usually still more costly than employer-sponsored plans.

The average annual individual premium is about $7,200. That’s quite higher than other health insurance and the premiums could be much higher depending on your state and plan.

However, the ACA helps people pay for their insurance. The IRS provides tax cuts on health insurance premiums for people at 400 percent of the federal poverty with an ACA plan.

Check out the Health Insurance Advisor to help you find an individual plan.

Pros: Cheaper alternative to COBRA.

Cons: More expensive than other plans.


Short-term health plans

Before the ACA, short-term health plans were a low-cost alternative to regular health insurance. The short-term plan market took a significant hit with the ACA, which required the plans provide the same level of coverage as regular health insurance. That coverage includes the 10 essential health benefits, including hospitalization, emergency, maternity, prescription drug, mental health and preventative coverage.

The Trump administration made a change to those plans for 2019, which allow the plans to sidestep coverage requirements once again. Most Americans are now eligible for short-term coverage. Another difference is that people can now have short-term plans for a year and renew twice. So, in effect, you could have a short-term plan for three years.

The result is lower-cost plans that can offer little coverage with hefty out-of-pocket costs. So, you may pay low premiums but will have to pay more for health care services.

Pros: Low premiums.

Cons: Fewer consumer and patient protections and potentially high out-of-pocket costs.


Association health plans

Association health plans allow small businesses and sole proprietors to band together to buy health insurance.

AHPs no longer must provide the 10 essential health benefits. Also, the Trump administration lessened restrictions on companies banding together.

These plans offer low-cost solutions but may offer limited coverage.

Pros: Low-cost alternative to individual insurance.

Cons: Fewer protections, you must meet AHP requirements.


Children’s Health Insurance Program

The Children’s Health Insurance Program (CHIP) is a state/federal program initiative that provides coverage for children whose families meet income requirements. Income requirements vary by state.

More than 9 million children are covered by CHIP, which is sometimes rolled into with a state’s Medicaid program.

Pros: Low-cost coverage and peace of mind that your children are covered.

Cons: Fewer physicians accept CHIP than employer-sponsored insurance.



How to choose a health plan

Once you figure out your options, you may find that you have multiple alternatives. For instance, your employer may offer different types of plans, including a preferred provider organization (PPO) plan and a high-deductible health plan (HDHP). Or you might have multiple Medicare Advantage options in your state.

When choosing between health plans, look at the costs associated with the plans. That includes:

  • Out-of-pocket maximums
  • Deductibles
  • Copays
  • Co-insurance

Think about how often you needed to use health care services over the past year and what you expect for the next year. You can’t predict exactly how much you’ll require, but you may be able to figure out approximately what you need. For instance, you might be starting a family or you may need to finally get help with your back or knee. Figure out what you might need and that can help guide through which plan to choose.

Then, make sure your physicians are part of the plan’s network of providers. If not, you may not be able to see the provider or will have to pay more for those office visits.

Also, think about what you want from your plan. Do you want to see any doctor and don’t mind paying higher premiums, a PPO might be a good choice. If you want to pay low premiums and don’t mind paying more for actual services, then an HDHP could be a wise decision. If you don’t care about getting a referral to see a specialist and don’t find a restricted network of providers, a health maintenance organization (HMO) plan could be right for you.

Before making your decision, check out the Best Health Insurance Companies page on Insure to read reviews of health insurance companies.

No matter which type of health insurance plan for you, make sure you go through the process to find the right health plan for you.

Healthcare, Insurance

Guide to Short-term Health Insurance

Originally published on

Most Americans have an additional health plan option in 2019. Short-term health plans are a low-cost plan. Don’t confuse them with standard health insurance plans though.

Yes, they provide health coverage, but they fall well short of what’s considered health insurance under the Affordable Care Act (ACA).

The ACA restricted short-term plans to young people and Americans who couldn’t afford any type of insurance. However, the Trump administration implemented a new policy for 2019 that will now allow anyone to apply for a short-term plan.

These are not catastrophic health plans. Catastrophic health plans are more commonly referred to as high-deductible health plans. Those plans as the name suggests have high deductibles.

High-deductible plans have low premiums and high out-of-pocket costs, but they provide all the protections of a health insurance plan. Short-term health plans aren’t considered an insurance plan because of their limited protections. They are now yearlong options with a chance to extend two more years. Short-term plans previously only lasted three months and let people renew up to a year.

Ryan McCostlin, a healthcare advisor at Bernard Health, said short-term plans aren’t for everyone, but some Americans may want to consider the plans.

“More and more Americans are saying that figuring out health insurance is more like filing taxes than buying car insurance, and the resurgence of short-term plans for 2019 is a signal that there’s just another healthcare financial planning strategy to be considered by savvy consumers,” McCostlin said.

Let’s take a look at what’s a short-term plan, what it covers and what it costs.

What’s a short-term health plan?

Short-term health plans are low-cost, low-coverage plans. Starting in 2019, these plans are available for most people up to one year with the option to extend the plans twice. In effect, you could have a short-term plan for three years. That’s unlike regular health insurance, which doesn’t have time limits.

Not all states allow short-term plans. States that forbid the sale of short-term plans include:

  • California
  • Hawaii
  • Massachusetts
  • New Jersey
  • New York

Other states have regulations that restrict short-term plans beyond the federal rules. For instance, Maryland only allows short-term plans for three months with no renewals.

What does a short-term health plan cover?

What short-term plans cover varies widely. Federal regulations allow short-term plans to create their own coverage plans without any required mandates like a regular health insurance plan. So, you may find substance abuse treatment coverage in one short-term plan, while another might cover barely anything.

The Kaiser Family Foundation analyzed short-term plans available in 2018 and found that:

  • 43 percent don’t cover mental health services
  • 62 percent don’t cover substance abuse treatment
  • 71 percent don’t cover outpatient prescription drugs
  • None of the plans cover maternity care

“They have a lot of fine print exclusions,” cautioned Betsy Imholz, special projects director at Consumers Union. “It’s worth noting that 40 percent of pregnancies in the U.S. are accidental. So, women of childbearing age need to be mindful of that excluded coverage in short-term plans.”

The ACA requires health insurance plans cover the 10 essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder
  • Prescription drugs
  • Rehabilitation services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including oral and vision care

Those are now standard parts of health insurance. Not so for short-term plans. In fact, you might have trouble finding a short-term health plan that covers most of those services.

Short-term plans vary, so you might find one that covers prescription drugs, while others don’t.

Short-term plans with more benefits will cost more than ones that provide little protection.

There’s also the issue of being denied coverage. While ACA plans require that insurers approve everyone regardless of health status, short-term plans can reject you. Some states may require “guaranteed issue,” which means a plan must cover you, but the federal law doesn’t demand that for short-term plans.

A short-term plan may reject you if you have a pre-existing condition. Or that plan may charge you exorbitant premiums. That’s not allowed in ACA plans.

More than half of Americans who aren’t in Medicare or Medicaid have some type of pre-existing condition. A short-term plan is likely not a good choice for those Americans.

Imholz said short-term plans can also cap the amount they pay to cover you annually and can limit how much it will spend on specific services, such as hospitalizations.

So, if your short-term plan covers hospitalizations, but only up to $5,000, you’ll be the hook for any amount above $5,000. That’s one reason why it’s critical to dig into what a specific short-term plan covers before signing up.

Plus, short-term plans can bring hefty out-of-pocket costs. Many short-term plans have lifetime limits on what they’ll cover. If you have a short-term plan and you’re diagnosed with a costly illness, the plan may stop paying for care after a limit is reached, such as at $100,000.

Short-term plans can also limit what they pay for specific treatments and hospitalizations.

How much does a short-term health plan cost?

You can find a short-term health plan for less than $100 a month. Compare that with the average of nearly $400 for ACA-compliant health plans. Short-term health plan premiums are 80% less on average than ACA plans.

However, Imholz said premiums are just one piece of a financial puzzle. You must also look at a plan’s deductibles, copays, coinsurance and dollar limits and exclusions of services that aren’t covered in short-term plans.

You may find that a low-cost, short-term plan may actually cost you more in the long run than an individual health insurance plan.

“There are all sort of pitfalls in these skinny plans that may not be evident at first blush and aggressive marketing emphasizing their lower premiums may make them sound tempting. But short-term plans cost less in premiums because they cover less. If you fall into one of the many gaps these plans have, it will end up costing you a lot more in the longer run,” Imholz said.

Who should get a short-term plan?

Healthy people might benefit from a short-term plan’s low premiums as long you don’t need health services.

These plans can provide you with some coverage but can lead to substantial out-of-pocket costs. A short-term plan is likely not a good idea if you plan to start a family.

“Short-term plans are not a panacea. They’re not a good fit for everyone, but they should be included in any serious analysis of healthcare financial planning,” McCostlin said.

Some major health insurers, such as UnitedHealthcare, offer short-term plans. Don’t confuse that coverage with regular health insurance. Just because a big-name insurer offers a short-term plan doesn’t mean that plan will provide you with full health insurance coverage. It’s not always easy to distinguish between plans, so it’s critical to read the fine print.

“One thing consumers can do is to ask the agent or company for a Summary of Benefits and Coverage, which is a standardized form required for ACA plans to help people compare plans. If there is not one available, that’s an indicator that it’s not an ACA-protected plan,” Imholz said.

People with any illness and pre-existing condition like asthma or diabetes should avoid short-term plans. Even if a short-term plan covers you, your pre-existing condition will likely lead to significant premiums. The plan also won’t likely provide enough coverage to make it worth your while.

However, if you’re healthy and don’t plan on using healthcare services often, a short-term plan can be a wise choice. Just hope for a year full of healthy days and little time spent at the doctor’s office or in a hospital.

Of course, you can’t predict your health for the next year. Imholz gave the example of one woman who bought a short-term plan. She was healthy so thought it was a good fit. Then, she was diagnosed with diverticulitis. The plan covered that ailment, but not the infection that arose from the condition. The plan declined to cover the treatment and deemed it a pre-existing condition. That decision left her with thousands of dollars of medical bills.

“Accidents and illness often come unexpectedly, so while you may be healthy today, life can change in an instant. If you can swing a marketplace policy, it’s a much safer, better deal,” Imholz said.

Short-term plans are also an option if you need to bridge the gap between employer plans. You can buy COBRA insurance and keep your previous employer’s insurance plan temporarily. That’s expensive though.

A short-term plan is a lower-cost alternative to COBRA or an individual plan. It’s also better than not having any coverage at all.

“There are many Americans who are choosing between short-term plans and no coverage at all. For these consumers, short-term plans can be a good fit to protect against emergencies and unexpected accidents,” McCostlin said.

Healthcare, Insurance

What is Medicare: How Do You Get Covered?

Originally published on

Medicare is a federal health insurance program that covers about 44 million Americans. That’s about 15 percent of the population.

It’s the single largest payer of health insurance in the country. People become eligible when they turn 65. It’s also available for people under 65 with disabilities or those with end-stage renal disease.

You’re automatically enrolled in Medicare when you turn 65. As you approach 65, you’ll receive information about choosing a Medicare plan. This should come three months before you turn 65. You have until three months after your 65th birthday month to pick a plan. That gives you seven months to review your options before making a decision.

The effective date is the first day of the month when you’re eligible for Medicare if you sign up in the months before becoming eligible. If you wait to sign up for Medicare on the month when you’re eligible or the following month, the effective date is the first day of the next month.

What are the different types of Medicare?

There are four types of Medicare. These plans cover specific services:

Most Medicare beneficiaries have original Medicare (Parts A & B), but Medicare Advantage plans have gained popularity over the past decade.

Now, about one-third of Medicare beneficiaries have Medicare Advantage and that’s expected to grow in the coming years.

How do you find a doctor who takes Medicare?

One of your biggest concerns with switching health insurance might be: Will I get to keep my doctor?

An easy way to find a doctor or to see if your current doctor accepts Medicare is to check CMS’ Physician Compare. The tool lets you search by the provider’s name or the group practice name. You can also look by specialty, medical condition, body part or organ system. That will help you find specialists.

Once you provide the information, the site will give you a list of local providers with profiles and specialties.

Lindsay Engle, a healthcare expert with MedicareFAQ, said doctors who accept original Medicare (Parts A & B) might not take Medicare Advantage plans. About 96% of physicians accept Medicare, but you may find doctors who aren’t in Medicare Advantage networks.

“Your plan information will tell you what type of plan you’re currently enrolled in and what providers or networks you have to use. Your best option is to contact your doctor or physician’s office to see what type of Medicare plans they accept,” Engle said.

Do I need a Medicare plan if I turn 65?

Let’s say you’re 65 and you plan to work for a few more years. You’re happy with your employer-sponsored health plan and don’t want to give it up. Do you have to get Medicare?

You could go with only a Part A policy, which is free for most Americans.

That way you won’t have to pay premiums and still have your private health plan to help you with coverage, including doctor visits.

“Your Medicare benefits will work with your employer coverage,” Engle said.

Medicare and other insurers have something called coordination of benefits (COB). COB figures out which plan pays first for coverage if you have more than one plan.

For instance, if your employer has more than 20 employees, the COB will consider Medicare coverage a secondary payer. If your company has fewer employees, your Medicare coverage is primary and the employer is secondary.

The primary insurer pays initially and then the secondary payer covers its portion up to 100% of the total cost.

Having more than one type of health insurance is called “dual insurance.” Having dual insurance can help reduce out-of-pocket costs, but also means you may have to play two premiums. Plus, you could face two separate deductibles.

“Medicare as secondary insurance will cost you money. Part B is not premium free. Some beneficiaries choose to delay their Part B coverage if they have group coverage as their primary since it covers outpatient benefits usually. Since employer coverage is considered credible coverage, you won’t be penalized for delaying your Part B enrollment,” Engle said.

You’ll want to run all of those numbers to see whether keeping other coverage makes sense for you when you become eligible for Medicare.

How do I find a Medicare plan?

Not too long ago, people turned 65 and enrolled in original Medicare (Parts A and B). Now, seniors have multiple options, including Medicare Advantage.

You can go with Parts A and B, you can add on a Part D plan or you can choose one of many Medicare Advantage offerings.

You’re able to compare plans each year and pick the best one for you. Medicare recommends members consider:

  • Costs
  • Coverage
  • Your other coverage
  • Prescription drugs
  • Doctor and hospital choice
  • Quality of care
  • Travel

You also want to make sure your doctors or hospital are considered in-network. You might even want unrestricted access and not need doctor referrals. In that case, you might want to get a PPO, which is more expensive than an HMO but gives you more flexibility.

One way to figure out the plan for you is to check out CMS’ star ratings for the different plans. CMS rates plans between one and five stars with five stars being the highest mark. The ratings take into account membership surveys, quality and performance.

Besides the prestige of earning five stars, health insurance companies get a higher reimbursement from the government when they have a five-star plan.

Medicare Plan Finder lets you compare both traditional and Medicare Advantage plans in your area. The site will ask you a series of questions that will help you narrow the number of sites that interest. It will reveal each plan that may make sense for you, including premiums, deductibles, estimated annual health and drug costs and overall rating.

Once you find the plan for you, you can choose it on the site and fill out the necessary paperwork.

Should you choose traditional Medicare or Medicare Advantage?

Which Medicare works best depends on your situation, your area and what plans are available.

Engle suggests sticking with original Medicare (Parts A & B) if you want to keep your current doctor who doesn’t accept Medicare Advantage and the plan has better overall coverage than Medicare Advantage.

“You should consider a Medicare Advantage plan if you want medical and drug coverage combined into one plan, limit annual out-of-pocket costs and extra benefits like dental, vision and hearing,” Engle said.

You may find a plan with low premiums, but remember you get what you pay for. Plans with low rates may have high deductibles and out-of-pocket costs.

If it’s your first time choosing a Medicare plan, Engle suggests speaking to a licensed agent who works with multiple carriers. The expert will consider all of your options. Don’t rely on a friend or family member.

“Medicare is always changing, part of an agent’s job is to stay up to date with the most recent changes. Also, what works for your friend or family member may not work for you. Everyone has different healthcare needs,” Engle said.

When can I change Medicare plans?

Don’t worry about getting stuck in a Medicare plan you don’t like.

All Medicare beneficiaries can switch plans once a year. This happens during the annual open enrollment. Medicare’s open enrollment runs between Oct. 15 and Dec. 7. Any changes will take effect on Jan. 1.

However, Medicare beneficiaries can make changes during any time of the year if they go through certain life events. That can include if you move or you lose other health insurance coverage.

Here are some events that trigger a special enrollment:

  • Loss of coverage
  • Changes in household, such as a death
  • Changes in residence, such as moving to another state
  • Changes to your income

If you go through an eligible life event, you can make changes during a Special Enrollment Period. Changes made during a Special Enrollment Period usually kicks in the first day of the next month.

What is Medigap?

Medicare, just like any health insurance, can get pricey. Medigap is one way to help you pay for healthcare costs.

Medigap is a supplemental insurance. Original Medicare pays for 80% of your medical needs. Medigap covers the remaining 20% and out-of-pocket costs.

This is not a health insurance plan. Instead, the policy assists you to pay for services in Medicare Parts A & B. Those costs include copays, coinsurance and deductibles.

Medigap kicks in after Medicare pays its amount for covered healthcare services.

Some Medigap plans offer coverage not available in regular Medicare. For instance, you can get Medigap coverage for when you travel outside the country.

Private companies sell Medigap policies to individuals and not couples or families. So, if you and your spouse both want Medigap coverage, you each need to buy a policy.

“If you want all of your healthcare costs covered, a Medigap plan is your best option,” Engle said.

Healthcare, Insurance

5 Takeaways From Payer Q2 Earnings Reports

Originally published on Healthcare Dive.

Second-quarter numbers for payers showed a steady engine that has withstood the strain of the past two years, most notably (the failed) Republican efforts to tear up the Affordable Care Act and other big moves from the Trump administration.

Insurers appear to have found stability and responded by expanding offerings, pulling back on others, moving into new subsectors and partnering with or gobbling up other companies.

Payer underwriting margins were strong overall with no apparent ramp up in underlying medical consumption, David Windley, managing director for healthcare equity research at Jefferies in Nashville, told Healthcare Dive.

“2Q is a critical quarter for (managed care organizations) because it is the point at which management has seen enough actual data on claims payments to assess product pricing and any unusual trends,” he said.

Here are five trends and highlights from payers’ earnings reports in the past few weeks.

1. Payers love Medicare Advantage

Payers remain bullish on Medicare Advantage. Not only are traditionally strong MA payers growing their offerings, but more minor players are also expanding in the market.

UnitedHealth Group and Humana continue to have the two largest MA member populations. UnitedHealth’s MA population increased 10.4% year-over-year after picking up 450,000 new members. UnitedHealth views MA as a significant growth area and company officials said its long-term group rate is about 8%.

Meanwhile, MA drove Humana’s second-quarter earnings, which included a 5% increase in quarterly consolidated revenues. In a move to boost its MA plans, Humana recently purchased a 40% share of Kindred at Home with the right to buy the remaining interest over time. The payer expects that adding Kindred will help with end-of-life costs.

Another insurer growing its MA footprint is WellCare Health Plans. Medicare premium revenue grew more than 17% for WellCare, which offers managed Medicaid, Medicare and Medicare pharmacy drug plans.

The company said the increase was related to buying Universal Americanand organic growth. The Tampa-based payer ended the quarter at about 510,000 Medicare members, which was a 5% increase year-over-year.

WellCare’s pending acquisition of Meridian Health Plan for $2.5 billion is also expected to grow membership in Illinois and Michigan, as well as pick up MeridianRX, its pharmacy benefit manager business. “It will position us for future growth opportunities in government-sponsored programs, and we expect the transaction to be accretive,” Kenneth Burdick, WellCare’s CEO, said during the company’s Q2 call.

Anthem also spoke positively about its MA business, reporting a 14% operating revenue increase in its government business for the quarter. That was thanks to purchasing Health Sun and America’s 1st Choice as well as growing its Medicare membership organically.

Medicare enrollment grew by 254,000 year-over-year and membership in Medicare Advantage Part D plans skyrocketed by 37%. Anthem finished the quarter with 933,000 Medicare Advantage Part D members.

Anthem CEO Gail Boudreaux said the company plans to build its membership further by increasing its county footprint while finding organic growth where it already operates. She added that the Blues payer has found that members in their commercial plans want to transition to its MA plans once they reach retirement age.

“We have a strong pipeline of commercial customers who want to stay Blue,” Boudreaux said.

2. The individual market isn’t so bad after all

The days of widespread double-digit premium increases and payers fleeing the ACA exchanges appear to be over — or at least on hold.

During second-quarter earnings calls, multiple payers spoke of the ACA exchanges positively. Centene, which expanded its ACA footprint to 16 states this year, pointed to the exchanges as a major reason for its quarterly revenue growth. The payer, which has a large managed Medicaid population, has found success in ACA plans.

Centene is also looking to add new states next and grow further in the states where it’s already located.

Another payer that focuses on at-risk populations traditionally, Molina Healthcare, said it has seen better-than-expected ACA plan membership and risk-adjusted revenue.

Molina CEO Joseph Zubretsky said the risk profile of its reduced membership is also better. Last year, Molina pulled out of Wisconsin and Utah. Now, the payer is contemplating a return to those states and expanding to North Carolina.

“The issues we had in Utah and Wisconsin were mostly related to a network that was too wide and too highly priced. And the team is working at developing a network that will support the prices that we file … We’re going to watch every bit of data emerge on 2018 to make sure we have this right and then we’ll make the call at that point,” Zubretsky said during the call.

Even Anthem, which pulled back on the ACA exchanges along with other big-name payers last year, is looking at potential minor county expansions for 2019. Boudreaux said the insurer isn’t considering significant expansion, but it may move to abutting counties while focusing on areas with current Anthem individual plans.

“I think you’ll see some county expansions, but I think more focused on the areas that we’ve been this year, so not a major rescaling, but we are pleased with the performance. And again, it is all about stability and more certainty around that marketplace. But again, this year was solid,” she said.

Despite the better-than-anticipated ACA numbers, not all payers are interested in returning to the exchanges. UnitedHealth Group ended the quarter with 60,000 fewer individual plan members than a year ago.

UnitedHealth Group CEO David Wichmann said the nation’s largest private payer, which has 480,000 individual plan members, will continue a “modest presence” in that market. “Nothing has fundamentally changed since we made our decision,” he said about the exchanges. “It was the right decision for us.”

3. Commercial market results fell for some big players

Multiple payers have seen a drop in their commercial membership over the past year. UnitedHealth Group, Anthem, Humana and Aetna all reported decreases.

UnitedHealth Group said more commercial plans are moving to risk-based contracting.

The payer’s risk-based offerings increased by 50,000 members, while fee-based products decreased by 60,000. That’s part of a trend that Wichmann predicted during the first-quarter call in April. Wichmann said half of Americans will get care from a physician with a value-based contract within a decade.

Meanwhile, two payers, Humana and Aetna, reported that what companies want from payers is changing, especially small businesses. They’re seeing small group companies moving to contracts to perform administrative duties only.

Humana’s administrative services only plans increased by 3% to 458,800 members. The payer said small group membership made up just 7% of group ASO membership a year ago and 12% at the end of 2017. It was 18% at the end of the second quarter.

Humana’s commercial membership dropped 5% to slightly more than 1 million members as it lost large group accounts in self-funded accounts, but more ASO plans partially offset the loss.

Not all payers are seeing commercial plan decreases. Cigna picked up 329,000 customers year-over-year and ended the quarter with 16.2 million enrollees. “All the indicators we’re seeing … continue to reinforce [that] we see a very attractive growth outlook in the commercial space in 2019,” Cigna CEO David Cordani said.

Cigna has focused more on commercial plans after CMS temporarily suspended the payer from offering MA plans. Cigna got the OK to sell those plans again last summer.

4. Payers are looking at public plan opportunities

While payers are seeing sagging commercial plan membership, they’re finding growth potential in managed Medicaid.

Centene recently purchased Fidelis Care for $3.75 billion, which gives the payer the fastest growing Medicaid managed care company in New York and second fastest in MA. Fidelis’ 1.6 million members are spread across the ACA, MA and Medicaid markets. Centene expects to see more than $11 billion in revenue from Fidelis.

WellCare’s purchase of Meridian will make it the largest Medicaid payer in membership in Michigan and Illinois, where it has 508,000 and 565,000 members, respectively. WellCare said the deal will put it in the leading market position for six states.

WellCare will also grow Medicaid membership after being the sole winner for Florida’s Children’s Medical Services contract. The company expects the contract will increase its Florida Medicaid annual revenue stream by $1.5 billion.

Molina picked up nearly 70,000 members in the second quarter after a recent statewide Illinois contract.

There are other Medicaid opportunities for payers too, as more states show an interest in expanding Medicaid. Boudreaux said Virginia’s upcoming Medicaid expansion brings 400,000 possible members. Maine voters also approved Medicaid expansion last year and a growing number of states are putting expansion on the ballot this fall.

However, it is not all positive news for Medicaid payers. Humana’s state-based contracts membership, which includes dual-eligibles, decreased by 13% year-over-year. The decrease came after the payer didn’t participate in Illinois’ Integrated Care program and a Medicaid membership drop in Florida. That said, Humana expects improved Medicaid membership next year after a new Florida contract.

5. Industry is in good financial shape

The second-quarter reports show that payers (and most healthcare companies, actually) are doing well financially. Axios reported that publicly-traded healthcare companies enjoyed billions of dollars of profits in the second quarter. In fact, they’re making more than in Q1, especially pharmaceutical companies. Those numbers don’t include nonprofit hospitals, which face their own challenges.

Two financial numbers that stand out are the revenue results for Aetna and Molina. Aetna stayed stagnant, but it’s also in the middle of the CVS Health merger. Plus, it enjoyed a nearly 8% profit margin in the quarter.

Molina, meanwhile, went through upheaval over the past year when it ousted CEO Mario Molina and CFO John Molina, the sons of the company’s founder. The payer also pulled back on the exchanges. Hence, the revenue drop.

Looking ahead to Q3, Windley expects more of the same for payers. He said insurance companies will begin to publicly discuss their 2019 plans during the third-quarter calls, including potential MA growth.

Here’s a breakdown of important metrics to show how payers did in the second quarter:


Revenues: $15.6 billion

Compared to 2Q 2017: No change

Profit: $1.2 billion

Net profit margin: 7.8%

Membership: 22 million



Revenues: $22.7 billion

Compared to 2Q 2017: Up 2.3%

Profit: $2.4 billion

Net profit margin: 5.2%

Membership: 39.5 million



Revenues: $14.2 billion

Compared to 2Q 2017: Up 19%

Profit: $300 million

Net profit margin: 2.1%

Membership: 12.8 million



Revenues: $11.5 billion

Compared to 2Q 2017: Up 10%

Profit: $193 million

Net profit margin: 1.4%

Membership: 16.2 million



Revenues: $14.3 billion

Compared to 2Q 2017: Up 5%

Profit: $193 million

Net profit margin: 1.4%

Membership: 16.6 million


Molina Healthcare

Revenues: $4.9 billion

Compared to 2Q 2017: Down 2.3%

Profit: $202 million

Net profit margin: 4.1%

Membership: 4.1 million


UnitedHealth Group

Revenues: $56.1 billion

Compared to 2Q 2017: Up 12.1%

Profit: $2.9 billion

Net profit margin: 5.2%

Membership: 48.8 million



Revenues: $4.61 billion

Compared to 2Q 2017: Up 7.4%

Profit: $172 million

Net profit margin: 3.9%

Membership: 4.4 million


Personal Finance

A Whole New World of Rewards for Disney Fans

Originally published on Credit Karma.

You no longer have to wish upon a star to have Mickey Mouse, Tinker Bell or even Yoda on your credit card.

Disney offers two rewards credit cards through Chase that offer all kinds of Disney-related perks: Disney® Premier Visa® Card and Disney® Visa® Card. From fun Disney and Star Wars card art to the chance to earn Disney Rewards Dollars that you can use toward Disney products or vacations, these cards are perfect for fueling your Disney fanatic side.

Disney® Premier Visa® Card takes the perks one step further by offering a more generous rewards program and introductory bonus. These add-ons come with a $49 annual fee, while Disney® Visa® Card charges no annual fee, but we still think Disney® Premier Visa® Card is the clear winner between the two.

Let’s compare the cards side-by-side to find out why.

See Credit Karma page for side-by-side comparison.

The winner: Why we prefer Disney® Premier Visa® Card

Both cards offer great Disney benefits, but Disney® Premier Visa® Card gives a little bit extra. Yes, that “extra” come with a $49 annual fee, but you can more than offset the cost if you expect to use your card for everyday purchases or plan to use the card to pay for an upcoming flight.

Extra rewards

Disney® Premier Visa® Card lets you earn 1 percent in Disney Rewards Dollars on your everyday purchases and 2 percent at gas stations, grocery stores, restaurants and most Disney locations. Those locations include Walt Disney World® Resort, Disneyland® Resort, Disney Cruise Line and more.

With Disney® Visa® Card, you only earn 1 percent on all purchases.

Option to redeem points toward flights

With the Disney® Premier Visa® Card, you can even redeem Disney Rewards Dollars toward flights. There are no airline limitations or blackout days. Just pay for a flight using your Disney® Premier Visa® Card, then redeem your Disney Rewards Dollars for a statement credit toward your ticket purchase. (Just make sure you redeem them within 60 days of purchasing your ticket.)

This flight perk means you could use your Disney® Premier Visa® Card to book a roundtrip flight to a Disney resort, enjoy card benefits while you’re there, earn more Disney Rewards Dollars while you’re at it, then fly home and partially cover your flight by redeeming your Disney Rewards Dollars.

Note that with either card, once you rack up your Disney Rewards Dollars, you can use them toward Disney and Star Wars toys and movies at Disney Store or other Disney locations. You can also request a Disney Rewards Redemption Card once you collect 20 Disney Rewards Dollars. However, it’s only with Disney® Premier Visa® Card that you can redeem points for statement credit toward flights.

As a bonus, there are no limits on the number of Disney Rewards Dollars you can earn with both cards, so you have unlimited opportunity to save up for a big Disney trip or purchase.

Special events and discounts

The following special discounts and events are available to cardholders of either Disney card.

As a card member, you have access to exclusive events at Disney Store and VIP packages when you buy premium tickets to Aladdin or The Lion King on Broadway.

You get 10 percent off select merchandise purchases of $50 or more at Disney Store and, and at select locations at Disneyland® Resort, Walt Disney World® Resort, Disney’s Beach Resort Destinations and the Aulani Resort in Oahu, Hawaii.

You and six guests can also enjoy one Disney Character Experience per day at private cardholder locations at Disney parks. Plus, you can enjoy 10 percent off select dining locations most days at Disneyland® and Walt Disney World® Resorts.

Cool card designs

Both Disney credit cards offer card art that will be the envy of your Disney-loving friends. You can choose from 10 different designs, including the Magic Kingdom, Sorcerer Mickey and Elsa. There are cards with Yoda and Darth Vader for Star Wars fans, too.

Generous introductory bonus

We’ve gone over all of the Disney perks, but this card is more than just a rewards card for Disney purchases. You also earn a $200 statement credit when you spend $500 on purchases with Disney® Premier Visa® Card in the first three months from account opening.

With the Disney® Visa® Card, you only get a $50 statement after your first purchase.

Counterpoint: Why you might want the Disney® Visa® Card instead

Disney® Visa® Card offers many of the same benefits as the premier card, but without an annual fee.

You still get the choice of 10 card designs, the prestige of a Disney card and the chance to earn 1 percent in Disney Rewards Dollars on all purchases. But you miss out on Disney® Premier Visa® Card’s added perks.

When is Disney® Visa® Card a better bet? If you don’t plan to use it much.

Maybe you already have other cards and see the Disney card as a cool addition to your wallet, but not one you expect you’ll use that often. In that case, a card without an annual fee could be a better choice.

This card might also be a wise move if you’re interested in the Disney discounts and special events, but don’t care as much about the rewards program. This card earns 1 percent in Disney Rewards Dollars across all purchases, so you may not collect rewards as quickly. The premier card rewards can add up more rapidly, but that won’t matter if you’re not interested in the perks unique to Disney® Premier Visa® Card.


Teen Driving Safety: Least and Most Dangerous States

Originally published in

An analysis of states based on safety and insurance cost factors shows that Maryland, New York and Pennsylvania have the safest driving environment for teens, while Montana, North Dakota and Kansas have the worst.

Getting your license is a rite of passage for teens, but that privilege comes with responsibility. As teens get ready for prom season, looked at teen driver safety and insurance costs by state to see which states are the safest for teen drivers. We ran the numbers and found that the safest driving environments for teens are in:

  1. Maryland
  2. New York
  3. Pennsylvania
  4. Connecticut
  5. Massachusetts

On the flip side, the states with the worst numbers are:

  1. Montana (51)
  2. North Dakota (50)
  3. Kansas (49)
  4. Wyoming (48)
  5. Alabama (47)

This is the second year that performed this analysis. Maryland and Massachusetts are the only states from last year’s top three to again make the top three this year (Massachusetts and Alaska were first and third respectively last year).

Montana and North Dakota are again the bottom two states this year. Last year, Louisiana joined them as third from the bottom.

The analysis comes at a time when the latest numbers from the National Highway Traffic Safety Administration (NHTSA) show an increase in the number of teen driver-related fatal accidents.

The 2015 figures show that young drivers were involved in 1,886 fatal accidents. This is a 9 percent jump from 2014 (1,886 vs. 1,723). Teen drivers were also involved in 14 percent more crashes in 2015, according to the NHTSA.

Despite those sobering figures, young driver fatalities are still much lower than a decade ago. The NHTSA said fatal crashes involving young drivers dropped 43 percent from 2006 to 2015. That’s an encouraging trend despite the alarming 2015 figures.

Most and least safe states for teen drivers

To identify the best and worst states for teen drivers, analyzed five teen-driving metrics:

  • Number of teen driver fatalities per 100,000 population
  • Effectiveness of Graduated Driving License (GDL) components
  • Teen drinking and driving rates
  • Teen emailing/texting and driving rates
  • Average annual insurance costs for teen drivers, which is a reflection of the risk level for this driving group

We gave each state a weighted score to determine rankings, with the safest states topping the list and the states with the lowest scores at the bottom.

Maryland topped our list this year as the safest state for teen drivers, after finishing second last year. The state had a low number of teen-related fatal accidents in 2015 (.3 per 100,000 residents) and has some of the strongest GDL laws in the country.

Last year’s safest state, Massachusetts, dropped to fifth place this year. The Bay State continued having one of the lowest teen-related fatal accident rate and strong GDL laws, which helped it to edge out California and Virginia for the No. 5 rank.

The new Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System results about drunk driving and texting while driving were the major differences this year. Massachusetts survey numbers were worse than Maryland’s, which contributed to Massachusetts dropping from the top spot.

On the other side, Montana and North Dakota remained in the bottom two spots. Both states had a high per capita number of fatal accidents involving teens, lacked strong GDL provisions, and experienced poor teen survey results for drinking while driving and texting while driving.

Here is the full list from No. 1 to No. 51. SEE FULL CHART ON ORIGINAL ARTICLE.

Teen driver fatalities numbers on the rise

Despite much better numbers over the past 10 years, motor vehicle crashes are the number one cause of death for 15- to 20-year-olds, according to the National Center for Health Statistics.

Plus, the fatal accidents numbers for 2015 are a concern, but groups like NHTSA are working to move the trend back in the right direction.

“Obtaining a driver’s license is an important milestone in any young person’s life,” says the NHTSA. “It is also a privilege and responsibility that requires commitment from all parties involved. For teens, parents, driving instructors and peers, safety behind the wheel benefits everyone on the road ahead.”

Kara Macek, senior director of communications and programs at the Governors Highway Safety Association,  (GHSA) says some of the reasons behind the increase are an improved economy, so teens have more disposable income, people traveling more, and lower gas prices. Teens using social media and messaging apps behind the wheel also play a large role.

“Since there’s no one reason for the increase, advocates and officials need to take a multi-faceted approach to teen driver safety and look for a variety of solutions,” says Macek.

Older teens in more fatal crashes than younger teens

The GHSA recently released a report called “Mission Not Accomplished: Teen Safe Driving, the Next Chapter” that showed a higher rate of fatal crashes among older teens rather than 16- and 17-year-olds.

The GHSA analyzed fatal crash data from 2005-2014 that involved drivers 15 to 20 years old. Though teen driver involvement in fatal crashes decreased by 48 percent in that time, the report dug deeper into the crash data and found that older teens account for most teen drivers killed during the 10-year period. The top age groups for fatalities were 19-year-olds, 20-year-olds, and 18-year-olds.

Macek says the figures are “alarming, though not altogether unpredictable.”

Here’s one possible reason — limits on GDL provisions. GDL laws ease teens into driving while they mature behind the wheel. The GDL process usually includes a learner’s permit, an intermediate license, which puts limits on driving, and finally a license with full privileges. The limits often restrict nighttime driving or operating a vehicle with other teens in the car.

The GDL laws usually stop at the age of 18, which means older teens have fewer driving restrictions. This could be a factor in the higher percentage of fatal crashes for older teens.

Macek says many teens wait to get their licenses at 18 or 19, which means they don’t have to comply with GDL restrictions — though they’re new drivers.

“As the report shows, one in three teens isn’t licensed by the age 18, which means that when they get their license, they often aren’t going through the graduated driver licensing process and getting the education necessary to learn safe driving skills,” says Macek. “For teens that were licensed at 16 or 17, by the time they’re 18 or 19, they’ve gotten comfortable driving, forgotten some of the training, and are likely to start taking more risks — even though they’re still fairly inexperienced drivers.”

As a way to combat this issue, Macek says the GHSA suggests that all states increase GDL laws for drivers until the age of 21. Only New Jersey has that kind of restriction.

“Expanding GDL would ensure that the vast majority of people getting a driver’s license for the first time have received adequate training and education on safe driving,” she says.

The GHSA is advocating that states strengthen GDL laws to improve driver safety.

“While 18 may be the age of majority in most states, its arrival does not mean a teen driver is now risk-free,” said the GHSA in its report. “It takes time — as much as three to five years — for a teen driver to gain the experience and the maturity needed to advance from being competent and tactical to strategically skilled.”

Graduated license laws 

Both the GHSA and NHTSA agree that GDL laws have played a key role in reducing fatal accidents involving teens over the past decade.

“For the most part, GDL is the most effective countermeasure we have seen that contributed to the decline in teen driver fatalities,” says Macek.

States devise their own GDL system, so there are great variations between states. States with the strongest GDL laws have seen the highest reduction in fatal-related crashes, according to the Insurance Institute for Highway Safety (IIHS) and the Highway Loss Data Institute (HLDI).

According to IIHS, 13 states could sharply reduce fatal crash rates among 15- to 17-year-olds if they adopted the five strongest GDL provisions. The five states that could reduce teen fatal crash rates the most with more effective GDL laws are:

  • South Dakota — 63 percent
  • North Dakota — 56 percent
  • Iowa — 55 percent
  • Montana — 53 percent
  • Arkansas — 50 percent

To find how your state fares for effective GDL laws, see the map below; hover on your state to see the numbers, as well as each state’s teen fatal stats, compared to the national average. 


Drunken driving

Drunken driving leads to more accidents, and it’s a problem among teens even though they are not at the legal drinking age yet.

GHSA estimates that 10 percent of young teens and 20 percent of older teens involved in fatal crashes had blood alcohol levels of .01 percent of higher. This is especially a problem for males. GHSA said male teens were twice as lightly to have a blood alcohol level of .08 percent than teen females. Teen males are also less likely to wear a seatbelt.

“Teen males can be a hard group to reach, but the report cites evidence that one of the best ways to message this audience is through key influencers like musicians and athletes,” says Macek.

Here’s how states rank regarding percentage of high school students age 16 and over who reported drinking and driving in a Centers for Disease Control and Prevention survey.


Texting and driving

While drunken driving and seatbelt use are a bigger issue for male teens, female teens are more apt to drive while being distracted. This could include using a cell phone, texting, or talking to other people in the car.

“Getting teens to stop driving distracted is part of a larger cultural shift that needs to happen to get people to put their phones down and focus on driving,” says Macek.

Macek says one way to reduce distracted teen drivers is for parents not to text or use their cell phones when driving. Teens mimic parent behavior.

“NHTSA believes learning safe driving habits can also be derived from observation and parental involvement. A parent being involved in their teen driver’s education can have a lasting effect on their driving habits. Establishing rules and providing input into their driving behavior can better prepare them for situations they will encounter on their own. Surveys have shown that teens whose parents impose driving restrictions and set good examples typically engage in less risky driving and are involved in fewer crashes,” says the NHTSA.

Parents play an important role, but found in a survey last year that most of the 500 parents surveyed allowed their kids to break at least one GDL law (59 percent).

Here’s how states rank for percentage of high school students age 16 and over who reported driving and texting or emailing, according to a CDC survey.


Insurance costs for teens

Insurance companies consider teen drivers as high-risk drivers because of their driving inexperience and youth. It can cost thousands of dollars to insure teens. There are factors beyond age, too, including the amount and cost of claims, driving record, and type of car.

Here are how states rank from most to least for insurance costs for teens



For overall ranking, each state was scored from 1 to 5 (1, poor, 2 fair, 3 good, 4 very good, 5 excellent) on each metric. Metrics were weighted as follows: Insurance cost – 10%; Fatal teen crashes – 30%; Leniency of GDL laws – 20%; Teen drinking and driving – 20%; Teen texting and emailing – 20%. Data shown for individual metrics is ranked by raw number. In cases where a state did not participate in federal surveys, the national average was used.


Car insurance rates: commissioned rates from Quadrant Information Services for six major carriers in 10 ZIP codes in each state for coverage of 100/300/100 with a $500 deductible for ages 16, 17, 18 and 19.

Fatal crashes: Teen driver fatalities from the National Highway Traffic Safety Administration statistics report “Fatalities in Crashes Involving a Young Driver (Ages 15 – 20) by State and Fatality Type; 2015 Fatality Analysis Reporting System” were divided by the 2015 state population. The result was multiplied by 100,000 to get a rate per 100,000 population.

Graduated Driver License specifications and effective licensing provisions: Insurance Institute for Highway Safety/Highway Loss Data Institute; Governor’s Highway Safety Association. GDL laws scored on estimated percent reduction of teen fatal crash rate if stricter laws in place.

High school teens drinking and driving: Centers for Disease Control and Prevention, Youth Risk Behavior Survey 2015.

High school teens texting or emailing while driving: Centers for Disease Control and Prevention, Youth Risk Behavior Survey 2015.


Health Insurance Guide: Which Plan is Right for You?

Originally published on

Which health insurance plan is best for you?

The answer to that question really depends on a number of factors that pertain to your specific situation. When comparing health plan options, take these factors into account:

  • Your health
  • Your family’s health
  • Your health care providers and whether they accept the insurance
  • Your financial situation
  • Whether you want to pay more upfront via premiums
  • If you want flexibility and not having to ask for referrals to see a specialist

Once you review those factors, choosing a health plan is much easier.

The five most common types of health insurance plans are:

  • Preferred provider organizations (PPOs)
  • Health maintenance organizations (HMOs)
  • High-deductible health plans (HDHPs)
  • Point of service plans (POS)
  • Exclusive provider organization plans (EPO)

The two most common health plans have been generally HMOs and PPOs, but HDHPs have become a lower-cost health insurance option for employers over the past decade. POS and EPO plans are options provided by some employers and health insurers, but they’re not nearly as common as HMOs, PPOs, and HDHPs.

In this guide, we provide information about each of these plans to help you make the right decision for your circumstances. We will go through each of the five plan types and highlight the differences.

What is a PPO?

PPO stands for preferred-provider organization. Premiums and deductibles are usually much higher for a PPO compared to an HMO, but that comes with greater flexibility.

About one-half of enrollees in employer-based health plans are in a PPO. Though it remains the most utilized type of plan, the number has been falling in recent years as employers turn more to HDHPs as a way to contain health care costs.

You usually don’t have to select a PCP in a PPO plan, and you can choose from more healthcare providers than an HMO because PPO networks are usually larger. PPOs allow you to get both in-network and out-of-network care — though out-of-network providers will be covered at a lesser percentage. You can also see a specialist without a referral.

Though a PPO gives you more independence, this doesn’t mean that you have complete access to the health care system without any oversight. A health plan may still require you and a physician to get approval for a costly service, such as an MRI.

In addition to higher premiums, PPOs usually have a deductible that you have to meet before the health plan pays for care.

Kaiser Family Foundation reports the average deductible for an individual PPO plan is $1,028. Once you’ve reached your deductible, your insurer begins to pick up its portion of the coinsurance.

The plans also include an out-of-pocket maximum for in-network care. If you reach your out-of-pocket maximum, all costs are covered by your insurer. A plan’s out-of-pocket maximum can vary widely, so you’ll need to check to see the out-of-pocket maximum for your plan. For Marketplace plans through Obamacare, the maximum out-of-pocket limits for 2017 are $7,150 for an individual plan and $14,300 for a family plan.

The main benefit of a PPO is flexibility, but it does come at the cost of higher premiums and a deductible that you will have to pay before your insurer starts paying for care.

When a PPO might be right for you:

  • You want the flexibility to go out of network and not need to get referrals.
  • Flexibility is more important to you than paying higher premiums.
  • You would rather pay higher premiums, but likely pay less for the health care services.

What kind of person should opt for a PPO: Someone who utilizes health care regularly and sees specialists or wants to have the option to see a specialist without getting a referral.

What is an HMO?

HMO stands for health maintenance organization and makes up about 15 percent of health plans. It is known for its lower premiums and restricted network of doctors and hospitals, which means you sacrifice flexibility for lower upfront costs.

You’ll likely pay less in premiums for an HMO compared to a PPO – sometimes significantly less.

HMOs require that you name a primary care physician (PCP) who “coordinates” care, meaning your primary doctor must refer you first in order to see a specialist. HMOs usually don’t have deductibles (or they are lower than other plans). Instead, you pay copays for office visits, tests, and prescriptions.

One drawback to an HMO is that these plans usually don’t allow you to go outside your network for care. If you do, you’ll need to pay for the care on your own. An exception is if you need emergency care, which requires the facility (but not necessarily the providers) to bill as in network.

Not all providers accept HMOs, so before choosing an HMO, make sure your provider or providers accept the plan.

When an HMO might be right for you:

  • You have a primary care physician and other providers who are in the HMO network.
  • You don’t see many specialists and don’t need referrals often.
  • You don’t mind the limitations of only seeing providers in your network.
  • Cost is more important to you than flexibility.

What kind of person should opt for an HMO:  Someone who wants to pay as little as possible in premiums though not have to face high deductibles. An HMO could be a good option if you have a PCP and your other health care providers are already in the HMO.

What is an HDHP?

HDHP stands for high-deductible health plan, which is also sometimes called a CDHP (consumer driven health plan). HDHPs have grown in popularity as more employers have begun offering the plans as a way to contain health care costs.

Nearly one-third of workers have an HDHP.

Unlike the other plans, an HDHP can vary depending on the specific plan. For instance, one HDHP could be very similar to an HMO, while another could look more like a PPO. The critical piece of an HDHP is the size of the deductible and Health Savings Account that is attached to it.

The deductible is usually higher in an HDHP compared to other plans. The IRS defines an HDHP as any plan with a deductible of at least $1,300 for an individual and $2,600 for a family. You need to pay that amount for care before your health insurance chips in.

The average HDHP deductible is a little more than $2,000, but one-fifth of HDHP plan enrollees have a deductible of more than $3,000, according to the Kaiser Family Foundation.

You’ll want to keep that in mind if you choose this plan, and you should set aside money for the deductible in case you need it.

HDHPs typically feature a Health Savings Account, which allows you to save money pre-tax to pay for qualified medical expenses. Some employers seed money in employee HSA accounts to help pay for care, so you’ll want to see if your employer provides money to employee HSAs when making a health plan decision.

Much like a PPO, your insurer will begin to pay its share of the coinsurance once you’ve reached your deductible. Your insurer will cover all costs once you’ve hit your out-of-pocket maximum.

HDHP usually have lower premiums so they can be a less costly plan option — as long as you don’t need a lot of medical care. HDHPs might be a good idea if you are young and healthy, but could be costly to older adults or young families.

Before deciding on an HDHP, think about your next year of potential health care costs to see whether the lower premiums will more than offset the potential costs of care.

When an HDHP might be right for you:

  • You don’t have many health care costs, and you don’t expect to have many costs over the next year.
  • You’d rather pay less upfront costs in premiums with the understanding that the higher deductible means you’ll pay more out-of-pocket if you need care.
  • You don’t have children and/or a spouse on your plan who may use a lot of health care services.

What kind of person should opt for an HDHP: Someone who is healthy and doesn’t expect to use many health care services within the next year. You want the cheapest premiums and don’t mind having to pay a high deductible if you need a lot of care.

What is a POS?

POS stands for point of service plan and makes up about 10 percent of health plans. POS plans are not nearly as common as PPOs, HDHPs, and HMOs. POS plans are a hybrid of PPO and HMOs. In fact, point of service means that the health care consumer gets to choose whether to use HMO or PPO services each time you see a provider.

POS plans usually have similar rules to HMOs (for instance, you need to choose an in-network physician as your PCP), but you can see an out-of-network physician for a higher fee in a POS plan.

When a POS might be right for you:

  • You have a PCP in the POS plan.
  • You want the flexibility of going out of network like a PPO — and don’t mind paying the higher out-of-pocket fees when you need to go out of network.
  • You’re good at keeping health care receipts. You don’t mind filling out forms and sending in bills for payment if you get care out of network.

What kind of person should opt for a POS: Someone who likes being able to go out of network for care, but also wants a PCP coordinating your care.

What is an EPO?

EPO stands for exclusive provider organization and is a managed care plan that requires you to go to doctors and hospitals in the plan’s network.

You don’t need to choose a PCP or need a referral, so in that sense, it’s similar to a PPO, but you will only receive coverage for providers in your network. Other parts of an EPO plan are similar to an HMO, such as having a limited network of doctors and hospitals. You can’t get care outside the network unless it’s an emergency.

Much like a PPO, you need to get approval from your health plan in order to get what’s deemed as an expensive service.

When an EPO might be right for you:

  • You want the flexibility of a PPO and don’t need a referral as long as you stay in-network.
  • You’re OK having a limited network of doctors and facilities like an HMO.
  • You want a network like an HMO, but don’t want to choose a PCP.

What kind of person should opt for an EPO: Someone who doesn’t mind have a limited number of doctors and facilities and would rather not have to get a referral to see a specialist.

What is the difference between HMO, PPO, HDHP, POS and EPO?

It’s open enrollment season at your job and your employer offers you a choice between the three biggest plan types: HMO, PPO, and HDHP. Which is best? It really depends on your financial and medical situation – and preferences.

For instance, would you rather the flexibility of not having to go to a smaller group of providers in an HMO and don’t mind paying more upfront for your care via premiums? Then, a PPO might be right for you.

Do you not care about having a large network of providers, but paying as little as possible for health care is more important to you? Then, an HMO could be perfect.

Do you not use medical services often and you want a plan that will protect you, but not cost much in terms of upfront premiums? Then, an HDHP could be the direction to go.

Choosing the right health insurance plan is a personal decision and depends on your situation and preferences. Whether you ultimately choose a PPO, HMO, HDHP, POS or EPO, take costs, flexibility, coverage and convenience into account when making that decision.

Type of plan Average deductible* Require PCP? Need referrals? Out of network care
HMO $917 Yes Yes No
PPO $1,028 No No Yes
HDHP $2,199 Varies Varies Varies
POS $1,737 No No Yes, but costlier

*Kaiser Family Foundation, 2016 Employer Health Benefits Survey. Note: The survey did not include the average deductible amount for an EPO.