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Each health insurance plan is different and what works for your neighbor might not be a match for you and your family. But no worries—we’ll guide you through the important things to consider before you choose a plan.
Are all the things a plan covers.
Are what you pay for, like premiums, deductibles, and co-pays.
Refer to which doctors, facilities, and healthcare services a plan will and won’t cover.
Benefits are services or products your health insurance covers. There are many different combinations of benefits you may get as part of your health insurance plan. The following are a few examples of benefits a plan might cover:
A group of doctors and healthcare providers who have contracted with a health insurance company to offer their products and services at a pre-determined rate. You can use providers and pharmacies outside the network, but this will require you to pay more out of your pocket. If you have a specific doctor you want to see, you should make sure they’re in-network for the plan you choose.
There are two main types of plans to get to know before you buy. Also, if you have a specific doctor you’d like, that’s key.
To find out what you and/or your family’s healthcare needs might be it’s helpful to look at your healthcare spending from last year (unless you’re expecting major changes). To get a better idea, try the tool below—estimates are just fine. Just remember that unplanned healthcare costs can pop up anytime, but having health insurance can offer some protection in those instances.
To help you determine what’s important to you, rate the following on a scale from 1 to 3 based on importance (1 is mandatory, 3 not so much).
When shopping for plans, knowing the plan types below might be helpful.
Here’s how: the government is helping some people pay via subsidies and tax credits. Based on your family size, income, etc., you might be eligible for a subsidy that could decrease the cost of your premium. Try the below tool to see if you might qualify for a subsidy or tax credit.
NOTE: Quitting smoking may help decrease your premium too. Find out more about how to quit smoking by talking to a Walmart pharmacist.
Talk to a Licensed Representative to get more information
Find out more about your options by going through our guide for Health Insurance Options.
Individuals and families can go through the Health Insurance Marketplace or private insurance companies. Those who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) can get insurance through them.
You can compare plans based on price, benefits, quality, and other important factors before you choose. The four categories of plans are: Bronze, Silver, Gold, and Platinum. You’ll also find “catastrophic” plans for those under 30 or with very low incomes.
Enrollment Period: November 1, 2016 - January 31, 2017
Coverage Begins: as soon as January 1st, 2017
Documents You Need to Enroll:
Click here to begin shopping for the best plan for you and your family.
Provided through an employer or purchased individually through an agent.
Enrollment Period: varies depending on employer (always open if purchasing individually)
Coverage Begins: effective date determined at enrollment
Provides free or low-cost health insurance to lower-income individuals, families, pregnant women, and those with disabilities. Eligibility requirements are determined by state, so check with your local Medicaid office for more information. If you didn’t qualify before you might want to try again, as Medicaid eligibility expanded in many states in 2014.
Enrollment Period: open year-round
Covers children of families who don’t qualify for Medicaid, but can’t afford to buy health insurance. Every state operates its own CHIP, often with a unique name—some states combine Medicaid and CHIP.
Coverage Begins: at enrollment
Refers to Parts A and B, which are run by the federal government. Part A covers hospital-related services and emergency care. Part B covers services like doctor visits, lab tests, immunizations, and necessary equipment like wheelchairs.
NOTE: if you don’t enroll in Part B when you’re first eligible, or if you drop it and get it later, you may have to pay a late-enrollment penalty for as long as you have Medicare (your monthly premium for Part B could go up 10% for each full 12-month period you could have had Part B)
Offered by private insurance companies, these plans replace Original Medicare. They cover benefits that Parts A and B cover and can offer additional benefits, like vision, hearing, and dental. Most plans also include prescription drug coverage.
Plans that help pay for prescription medications—they’re only available from private insurance companies
NOTE: you might not need this if you buy a Medicare Advantage plan that includes prescription drug coverage.)
It’s available from private insurance companies and helps pay out-of-pocket costs not covered by Medicare Parts A and B (Medigap isn’t available to Medicare Advantage members)
Prescription Drug Plan
Replaces Parts A and B, available withor without prescription drug coverage
Prescription Drug Plan(If not included in primary plan)
Learn more about Medicare Part D plans at Walmart: www.walmart.com/rxplans
An important point to understand is that there’s a gap in coverage for many Medicare Prescription Drug plans—it’s also called the Medicare Donut Hole. You and your plan pay up to $2,960 for covered drugs. After you reach that amount, you’re responsible for 45% of the cost for brand-name drugs and 72% for generic. That holds until you’ve spent $4,700. Once you reach this amount, you only pay a small coinsurance, or copayment, for covered drugs. People who get extra help for prescription drug costs won’t enter the coverage gap. Want to know whether you’d qualify for Extra Help? Check out www.socialsecurity.gov/extrahelp.
$0 - $2900
$2900 - $4700
Chat with a pharmacist about whether you can switch to a generic prescription that might cost less.
Find the best deal on a blood sugar monitor, cane, walker, wheelchair, etc. through a government-approved supplier.
You and your doctor can use these appointments to create plans to help manage your health.
Speak to your doctor about switching to lower-cost, over-the-counter products.
You can sign up for it three months before your 65th birthday, and three months after you turn 65. If you enroll before your birthday, coverage usually begins the first day of your birth month. There is a penalty for enrolling late, so enroll in that seven-month period. Some people get enrolled automatically—those under 65 with a disability, who have ALS (or Lou Gehrig’s Disease), or are already receiving Social Security Benefits might be automatically enrolled in Parts A and B of Medicare. Check www.medicare.gov to see if you’ll be automatically enrolled.
Open enrollment is from October 15th through December 7th every year. During this time you can change, enroll in, or add additional Medicare coverage. Changes take place January 1st of the following year. You don’t have to re-enroll every year, you just have the chance to make changes during this time period. However, plans do change from year to year, so it’s important to read the info your plan sends you. Especially the “Evidence of Coverage” and the “Annual Notice of Change.” To make sure you’re getting coverage that is a good fit for you and is coverage that you can afford, review your monthly premiums and benefits.
The Health Insurance Marketplace doesn’t sell Medicare plans.
If you’ve experienced a life event that impacts your coverage, there’s a Special Enrollment Period so that you can make changes—like for instance, if you…
What do you need to enroll?