Choosing an individual and family health insurance plan
Looking for an individual and family (IFP) health insurance plan? Whether you’re shopping during the annual Open Enrollment Period (OEP) or recently qualified for a Special Enrollment Period (SEP), here’s how to choose an individual health insurance plan that fits your needs.
What is IFP health coverage and when do you enroll?
IFP health insurance is designed to cover individuals or families who need to purchase health care on their own. This may include those who are self-employed, college students and people who have lost their job-based health insurance or don’t receive health insurance through their employer.
You can enroll in an individual health plan during the Open Enrollment Period, which takes place from Nov. 1 through Jan. 15 each year. The enrollment deadline may vary by plan year. You can also enroll during a Special Enrollment Period if you experience a qualifying life event like turning 26, starting a family or moving.
Because everyone’s needs are different, coverage options vary widely among Wellmark Blue Cross and Blue Shield IFP health insurance plans. Here’s what to look for in an IFP plan.
What types of IFP plans does Wellmark offer?
IFP health insurance plans vary by insurance provider. Wellmark offers four types of individual and family health insurance plans in Iowa and South Dakota: traditional, high-deductible, standard — and if you live in certain Iowa counties — primary care health plans through UnityPoint Health.
It’s easy to compare standard and traditional health plans — both plan types offer predictable cost-share amounts since each plan comes with a designated deductible, copay, coinsurance and out-of-pocket maximum.
If you choose a high-deductible health plan (HDHP), you are responsible for the total cost of all non-preventive care until you reach your deductible. This may save you money if you don’t require much health care and typically only see a provider once a year for preventive services.
Wellmark’s primary care plans are like the traditional and standard plans mentioned above, but these plans operate exclusively using UnityPoint Health providers and facilities.
Wellmark makes it easy to compare plans and enroll online
With our digital shopping platform, you can easily compare health plans and — when you’re ready — enroll! Use it to find your Wellmark individual or family health plan.
What are metallic tier cost-shares?
Wellmark’s individual and family health plans operate on a metallic tier system: bronze, silver and gold. The metallic tiers describe how much you will pay versus how much will be covered by Wellmark. Gold tier plans have the lowest out-of-pocket costs with higher premiums, while Bronze plans have the highest out-of-pocket costs with lower premiums. Here’s the breakdown:
- Bronze tier: Wellmark pays 60 percent, and you pay 40 percent of your total costs.
- Silver tier: Wellmark pays 70 percent, and you pay 30 percent of your total costs.
- Gold tier: Wellmark pays 80 percent, and you pay 20 percent of your total costs.
If you anticipate needing a lot of non-preventive services, a gold or silver tier plan would give you the most value for your money. While your premium may be higher, your deductible will cost you less. On the other hand, if you think you’ll only utilize preventive care, a bronze tier plan will save you money on your monthly premium.
Is your provider in-network?
Making sure your providers are in-network is something you should always consider when choosing a health insurance plan. For most Iowa and South Dakota individual health insurance plans, preventive care from in-network providers is completely covered. However, if you select a traditional plan (a specific type of plan Wellmark offers), you’re encouraged to build a relationship with and seek care from your primary care provider (PCP). Services from your PCP will have lower out-of-pocket costs.
In most cases, staying in-network will save you money on the care you receive, which is why it’s important to make sure your providers are in-network.
What is your budget for an individual and family plan?
Cost is also important to consider when shopping for an individual and family health insurance plan. Before you choose a plan, consider the following:
You may qualify for a tax credit (subsidy)
Before you start shopping for a plan, check to see if you are eligible for a federal premium tax credit (subsidy). You can use our online shopping and comparison tool to find out if you qualify. The amount you can qualify for will depend on your income, household size and county.
How much care you will need
When comparing health plans, think about how much and what kind of care you anticipate needing throughout the year. Consider your age, diagnoses, prescribed medications and any other medical history. The amount of care you anticipate needing will impact how much you pay over the year in either premiums or out-of-pocket costs.
For example, if you have multiple prescriptions or anticipate a lot of care, you may want to choose a standard or traditional health plan. These plans offer more predictable payments because they come with deductibles and set prices for different drug tiers, biosimilars and specialty drugs.
On the other hand, if you don’t take prescription drugs, typically only need preventive care and are comfortable with some level of risk, an HDHP may be a good fit for you. Because you’re responsible for all costs (except for preventive care) until you reach your out-of-pocket maximum, you can expect lower premiums.
Cost-saving, narrow network health plans
If you’re shopping for individual and family health plans in Iowa, consider a Wellmark HMO | UnityPoint Health plan. These plans are designed to make health care simple and affordable. They use a narrow network, meaning you will work with a local group of providers. Wellmark HMO | UnityPoint Health plans are a good option for anyone looking to save money because Wellmark has worked with UnityPoint to secure enhanced prices for these plan members, and those savings are passed on to you.
You must reside in certain Iowa counties to enroll in a Wellmark Blue HMO | UnityPoint Health plan.
Finding individual health insurance in Iowa and South Dakota
With a clearer understanding of IFP health plans, you can enter your health insurance shopping journey with confidence. Start by comparing individual and family health insurance plans in Iowa and South Dakota.
Need help deciding which plan is right for you? An agent will guide you through the things to consider when choosing a health plan and help you compare health plans. Find an agent near you today.