It sounds cliché, but your health is the most valuable thing you have. (The COVID-19 pandemic has made that very clear.) That’s why it’s important for you to carefully evaluate your health insurance options each year.
Enrolling in a health plan for individuals and families can help you and your family get or stay healthy by giving you access to the care you need, whenever you need it.
It’s incredibly important to select the right plan and insurance company, but the process can feel overwhelming. So what’s the best way to get coverage that meets your health care and budgetary needs?
Break the process into steps. This can alleviate the pressure and make the task seem more manageable. The most important thing to do is to start early and take your time as you assess your situation.
Step 1: Determine what you and your family need.
You are picking a plan for the next year, so it’s important to think about how often you might use your coverage in the coming months. When you choose a plan, make sure it will provide access to programs and services that will meet your family’s health needs and goals.
You want to select a high-quality plan that offers these benefits:
Access to top-ranked doctors and hospitals: It’s important to be able to go to doctors and hospitals you know and trust.
$0 preventive care: Screenings, immunizations/vaccines, and health exams are all preventive care services that can help you and your family stay healthy. Make sure the plan you choose offers these services for free.
No-cost preventive medications: Check the details of the plans you’re considering to determine if your prescriptions will be covered. Some may be available at no cost to you.
Telemedicine: Virtual visits allow you to connect with health care providers right from your tablet, computer, or smartphone. You can use them to get care for non-emergency conditions— such as cold and flu symptoms, sinus infections, and rashes—no matter where you are. Some telemedicine services even allow providers to send prescriptions to your preferred pharmacy.
Counseling sessions: Some health plans provide coverage for over-the-phone counseling sessions. These can be helpful if you need support to work through family, relationship, or work concerns. Depending on the plan you choose, you may also be able to get free consultations related to financial wellness or legal issues.
Free health coaching: Coaches can support you in making lifestyle changes or managing health a condition, but make sure the plan you choose offers this service for free.
An app that gives you access to your insurance information: Be sure to select a plan that makes it easy for you to access your member ID card, live chat with customer service, and manage other important aspects of your health insurance.
Excellent customer service. It’s important to be able to talk to someone who is knowledgeable about your plan and can answer any questions that arise throughout the year.
Step 2: See if you are eligible for financial assistance.
It is possible to get everything you want in a health insurance plan and get help paying for it.
Depending on your income and family size, you may qualify for federal help to pay your monthly bill or for the care you receive.¹
To determine whether you are eligible for financial assistance, you must estimate your income through either the UPMC Health Plan Marketplace or Pennie, Pennsylvania’s new health insurance marketplace. Your estimate must include the income of all household members who are required to file a tax return, including those who aren’t enrolling in health insurance coverage. Your estimated income is based on your modified adjusted gross income (MAGI). Below are the types of income that are included in your MAGI:
- Federal taxable wages
- Self-employment income
- Unemployment compensation
- Social Security
- Social Security Disability Insurance (SSDI) income
- Retirement or pension
- Capital gains
- Investment income
- Rental and royalty income
- Excluded foreign income
Step 3: Select your plan and enroll.
Once you’ve found a plan that you believe will meet your family’s needs, it’s time to get covered!
UPMC Health Plan offers a variety of plans and makes it simple to get covered. You can also get help to assess your options and choose the plan that’s right for your family.
- Call 1-833-776-4536 (TTY: 711).
- Enroll online at upmchealthplan.com/marketplace.
- Visit a UPMC Health Plan Connect Centers. Call 1-855-306-8834 (TTY: 711) to find the location nearest you.
Eligibility for financial assistance is based on annual adjusted gross income. Annual income amounts are determined by the federal government. You must confirm your eligibility for financial assistance on the Pennie website.