Deciding on which health insurance plan you should be using can be difficult. There are many components that you need to take into account when making your decision. Below we have prepared a step-by-step guide to help you pick the ideal health insurance plan for you.
1.) Where To Look For Insurance
There are multiple ways to get health insurance. These include through an employer, a private exchange, and the state marketplace. If your employer offers insurance, your best choice is to go through their plan. Your employer will pay a portion of your premium, which means your cost is going to be much less than other ways.
If you aren’t offered health insurance through work or you’re self-employed, you should start by looking at the state marketplace. You can access the marketplace by visiting Healthcare.gov and inputting your location. Plans from the state’s marketplace are eligible for income-based discounts on monthly premiums.
Alternatively, you can look for a private health insurance plans directly from any insurer. Just be aware that this option will likely be more expensive than the two above, as there are no employer contributions or income-based discounts.
2.) Decide On Which Plan Type Is Right For You
There are a few different types of health insurance plans that you can get. The price of the plan and the doctors you are eligible to see vary from plan to plan.
HMO: Health Maintenance Organization
PPO: Preferred Provider Organization
This plan allows for you to seek medical assistance from providers outside of the plan’s network. In addition, you can see specialists without having to get a referral from your primary care physician. It’s important to note that while you can get care outside of the network, the cost of the care is cheaper with in-network doctors.
EPO: Exclusive Provider Organization
This is very similar to the HMO plan, except you don’t need a referral to see a specialist.
POS: Point Of Service Plan
Somewhat similar to the PPO plan, this coverage allows you to seek out-of-network care as long as you have a referral from your in-network physician. You need to also get a referral to see a specialist.
3.) Compare The Networks
As we discussed above, specific plans require you to get care within a closed network. If you already have a primary care doctor that you like, you should look for a health insurance plan in which they are in the network.
Different providers offer different size networks. If you want the luxury of multiple options for your health care, look for a plan that has a very large network. You should start by eliminating plans that don’t have providers in your local area. Then continue on to narrow down your list even further with the specifics mentioned above.
4.) Look At The Out-Of-Pocket Fees
Deductibles, copayments, and coinsurance are all terms that mean you are paying out of your pocket. These fees come along with any health insurance plan, however, each plan has different amounts for different services. As a rule of thumb, the higher your monthly premium payment, the less out-of-pocket fees you will be paying. In contrast, the lower the monthly premium payment, the more out-of-pocket fees you will be paying.
If you have a medical condition where you frequently see doctors, take expensive medication, or have major upcoming medical plans such as surgery or birth, you should go with a higher monthly payment. Contrarily, if you don’t see the doctor often and are in good health, it’s advisable to go with the low monthly payment plan.
5.) Look At The Benefits
You should look at the summary of benefits that each plan offers. This summary is a wide scope of the services in which the insurance plan will cover you for. Some policies may have a wide range of covered services, such as physical therapy and mental health care. Others may have a smaller range, but offer more coverage in areas such as emergencies. Look for the plan that has the most benefits in the areas you and your family need.