Understanding Your Individual and Family Plan Options
As Open Enrollment approaches, it’s a good time to evaluate whether your plan is still working for you or if a change is needed. If your needs have changed in the past year or you would like to consider another plan, take this opportunity to explore what else is offered in your area. Shop and compare plans at marketplace.viabenefits.com between November 1 and December 15.
Via Benefits works with a range of insurance carriers, both long established and relatively new. While you may not recognize all of the carriers we work with, Via Benefits ensures all the plans on our platform are qualified.
Reviewing Plan Options
Narrow your choice by evaluating each plan's characteristics.
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
Lower-premium plans cover a smaller percentage of expenses while higher-premium plans pay more of your expenses.Deductible
Similar to car insurance, you'll pay a certain amount before coverage begins.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.
Plan Classifications
There are two main types of plans.
Marketplace Plans
If you are eligible for and want to receive a federal subsidy (Premium Tax Credit or Cost-Sharing Reduction), you are required to enroll in an Individual and Family Plans offered on federal and state marketplaces.
Private Plans
While not offered in every state, Individual and Family Plans purchased directly from the insurance carrier provide the same or similar coverage as Marketplace Plans and may even have a lower premium.
Via Benefits can help you determine and enroll in the type of plan that fits your needs.
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? The 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) and Preferred Provider Organizations (PPOs).
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 health care provider in their network.
Your choice depends on your preference for cost, provider access, and care coordination.
Protection Plans
Protection plans are a cost-effective way to manage unexpected out-of-pocket costs or expenses from a medical event. Read Get Peace of Mind with Protection Plans to learn more.
Did you know?
Standardized plan options help simplify comparison shopping by focusing on premiums and network differences. Contact a licensed benefit advisor to learn more.
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.
For non-emergency care, an HMO with a narrower network of providers may not cover you in all the places you travel.
If available, a PPO might be your best 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 provider’s telehealth options while traveling.
To view all the options available, add your preferred doctors to your Profile before searching for plans. This enables you to see all the plan options in your area that include your in-network providers.