With the 2015 health insurance open enrollment a little less than a week away, you may have just received a letter from your provider about the healthcare exchanges. Along with that letter, many people are about to find that the plan that they once had is different from the plan they are about to receive as their renewal. Effective this plan period, many of the minimum standards of coverage required by the Affordable Care Act are going into effect. This means that many of the plans from last year are no longer compliant with ACA guidelines, which is why your policy may be changing. Below are a list of items to review to determine the differences between your plans:


Your deductible is the amount that you must pay before your health insurance kicks in and begins to pay each year. Typically, the higher your deductible, the lower your monthly payment will be. However, should you have an unexpected health issue arise, you will have to pay more yourself.

Many of the plans are forcing individuals and families to increase their deductibles and absorb more of the cost themselves. So when reviewing your plan, make sure that you are aware of how much your deductible is and have a plan in place should you have to pay that deductible.


Health insurance policies have a limit called your “out of pocket maximum.” This amount is the maximum you would contribute towards your’s or your family’s health costs in a given policy year before the policy would pick up 100% of your health related costs. Your deductibles, copays, coinsurance, and other qualified medical expenses all contribute to your out of pocket maximum for the year.

The trend with the new ACA compliant plans has been a consistent push towards increasing individual’s and family’s share of the medical services rendered by increasing deductibles and out of pocket maximums. This keeps your monthly cost down, and as long as you stay healthy, you are spending less on healthcare overall. However, as soon as something happens, you could be stuck with significant bills.


Within your plan, there are several cost sharing provisions for certain aspects of the health care process. Most health plans have what are called co-pays and coinsurance. Your co-pay is a set price that you pay for a specific medical service, such as a doctor’s visit, and the insurance pays the remaining cost. Coinsurance is a percentage of the cost of a service that you receive that you are responsible for paying after your deductible is satisfied, but before your out of pocket maximum is reached.


The provider network associated with your plan plays a significant role in the premium, your access to medical care, and how much of the cost you have to pay yourself. The provider network determines which hospitals and service providers accept your insurance. If a service provider falls outside of the network associated with your plan, you could see your cost of care sky rocket. For example, a BlueCross BlueShield of Tennessee plan with a $4,000 individual deductible and a $6,350 individual out of pocket max would increase to a $8000 deductible and $19,050 out of pocket max if the services were provided outside of your coverage network.

Some of the loudest complaints we heard from people last year that enrolled themselves was that they did not fully understand the network they chose, which wound up costing them a tremendous amount of money out. But just as importantly, they were not able to see their preferred physicians because those doctors were outside of their coverage network. It is imperative to make sure that you know which networks all of your doctors belong to before you chose your plan.


This probably goes without saying, but much of the middle Tennessee area saw significant rate increases on their renewals this year. If you were one of those unfortunate people to get more than an inflationary increase, it is likely cause for considering what other options are available to you.

The bottom line is that with all of the drastic changes in the health insurance marketplace this enrollment period, you should be sure that you have reviewed your plan with a qualified individual. Independent agents, like us, can offer the same great plans as the health exchange at the same cost with the added benefit of a licensed agent who can explain it all to you.

If you are interested in seeing what a plan might run you, you can get a real life health insurance quote directly through our site!