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Good Health Insurance Plan
Getting a good health insurance plan is never an easy thing to accomplish. Here’s a start-to-finish guide to choosing the best plan for you and your family, whether it is through the federal marketplace or an employer.
1. Step: Find your marketplace
The most popular health insurance is the one obtained through the workplace. If you’re one of the people who do this then government insurance exchanges or marketplaces are unnecessary because your work is your marketplace.
If you want, you can still find alternative health insurance plans in the exchanges even if your workplace offers insurance plans. However, plans in the marketplace are likely to have significantly higher costs. This is because most employers that provide insurance pay a part of their workers’ premiums, so they’ll more often than not be the least expensive option.
Not every workplace provides a health insurance plan. If this is the case in your workplace then you can shop on your state’s Affordable Care Act marketplace – that’s if available – or the federal marketplace to find the cheapest and most affordable premiums. Go to HealthCare.gov and enter your ZIP code. You will be redirected to your state’s exchange if your state is green on the map below. Otherwise, you’ll use the federal marketplace
Health insurance may also be purchased through a private exchange or directly from an insurer. If you follow this path however, you’ll miss out on premium subsidies (which are income based discounts on your monthly premiums) as you will not qualify for them.
2. Step: Compare types of health insurance plans
Be wary of the dreaded three letter abbreviations while looking for plans. The most significant ones to lookout for are HMOs, PPOs, EPOs, or POS plans. The one you chose will help determine your out-of-pocket costs and which doctors you can see
When weighing your plan options its always best to look at the rundown of all the benefits each plan offers. Online market places normally provide the cost near the plan’s title and a link to the summary. A provider directory, which is basically just a list of doctors and clinics that are involved in the plan’s network, should also be on hand. If you are operating via an employer then ask your workplace benefits administrator for the summary of benefits.
As you weigh up the different plans you should put extra focus on your family’s medical needs. Look at past treatments types and amounts that you’ve received in recent history. Every medical expense cannot be predicted but being aware of trends help you make wiser decisions.
Plans such as HMO or POS require referrals meaning you need to see a primary care physician before scheduling a procedure or you should visit a specialist. Because this is mandatory, other plans are often preferred
POS and HMO plans have the advantage of having a lighter work load for you because your doctor chooses specialists for you and your doctor’s staff coordinates visits and deal with the medical records. If you choose a POS plan and go out of network, make sure you get the referral from your doctor to reduce out-of-pocket costs.
If you prefer to select your doctor yourself then you might be more satisfied with a PPO or EPO. An EPO may help you reduce costs if you find providers in network; this is more likely to happen in a larger metro area. A PPO may be better if you live in a remote or rural area with less access to doctors and medical care, as you may be forced to go out of network.
3. Step: Compare health plan networks
Insurance companies contract lesser rates with in-network providers meaning costs are lower when you go to an in-network doctor. It costs you and your insurance company more if you go out of network because doctors don’t have contracted rates.
If you have preferred doctors and don’t want to change them, make sure they’re in the provider directories for the plan you are considering. If you don’t have a preferred, you’ll likely want a plan with a large network so you can enjoy more options. A larger network is particularly important if you live in a remote area or community since you’ll be more likely to find a local doctor who takes your plan.
Eliminate any plans that don’t have local in-network doctors and those with very few provider options compared with other plans.
4. Step: Compare out-of-pocket costs
Costs are almost as important as network size. Any plan’s summary of benefits should clearly outline how much you’ll have to pay out of pocket for services.
The federal marketplace website offers snapshots of these costs for comparison, as do many state marketplaces.
There are some key health insurance vocabulary words that are very important for you to know. As a consumer your portion of costs consists of the deductible, copayments, and coinsurance. The total that you spend out of pocket annually is limited, and that maximum is also listed in your plan information. Basically, the lower your premium, the higher your out-of-pocket costs.
Cost-sharing options vary, so your aim is to thin your choices based on out-of-pocket costs. A plan that pays a higher portion of your medical costs, but has higher monthly premiums, is better if:
- You have a planned surgery coming up.
- You frequently need emergency care.
- You are expecting a baby, plan to have a baby, or have small children.
- You’ve recently been diagnosed with a chronic condition such as diabetes or cancer.
- You see a doctor, whether a primary physician or a specialist, frequently.
- You take expensive or brand-name medications on a regular basis.
A plan with higher out-of-pocket costs and lower monthly premiums is the financially smart choice if:
- You are in good health and rarely see a doctor.
- You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.
5. Step: Compare benefits
By this step, you’ve probably narrowed down your options quite a bit. To further thin them, go back and revise that summary of benefits to see which plans cover a wider scope of services. Some may have better coverage for things like mental health care or physical therapy, while others may have better emergency coverage.
Skipping this small but vital step could mean that you miss out on a plan better suited for you and your family.
Once you’re down to a couple of options, it’s time to address any lingering questions. In some cases, only speaking with a person will do, so call the customer service line of the insurers you’re considering. Write your questions down ahead of time, and have a pen or computer handy to record the answers.
Here are some examples of what you could ask:
- Which drugs for this disease are covered under this plan?
- What maternity services are covered?
- How do I get started signing up, and what documents will I need?
- How do I get started signing up, and what documents will I need?
- What happens if I get sick when traveling abroad?
Finally: Don’t forget to discontinue your old plan before the new one starts if you switch.
Checklist for Choosing a Health Insurance Plan
Below is a rundown checklist that summarizes the steps mentioned above:
- Go to your marketplace and compare your health insurance plan options side by side.
- Now, choose the type of health insurance plan, either PPO, HMO, EPO, or POS which best serves you and your family.
- Remove health plans that exclude your doctor or any local doctors in the provider network.
- Do ensure that any health plan you choose will pay for your regular and necessary care, like prescriptions and specialists.
- Determine if you want more lower premiums and higher-out-of-pocket costs or health insurance coverage policy and higher premiums.