The details of health insurance can be confusing. It’s important to understand how a plan works, particularly the monthly premium costs and the provider network coverage. It is especially important during open enrollment season and when deciding on your individual or family health insurance for the year ahead. Here are some tips to pick the right health insurance plan.
Determine Your Needs
Determining your current medical needs is the first step in picking a health insurance plan. Think about how often you visit doctors, get care at the hospital or receive prescription medications.
It is important to understand your medical needs because each health plan has different costs and coverage amounts. Each program also creates its own provider network and drug formulary, the list of covered drugs.
Although two plans may have the same medications on their drug lists, they may cover them differently (e.g., one plan puts the medicines in a lower tier and charges you less).
If you are switching to an individual or family health insurance plan from your employer, it is important to know whether or not your doctors will be included in the network.
You may also need to change pharmacies. You can find this information by checking each plan’s summary of benefits in the marketplace.
Then it would help if you compare each plan’s monthly premium, deductible and copays.
The deductible for a plan is the sum you must pay out-of-pocket for medical care before your insurance begins to pay. The monthly premium is the amount you pay for your health insurance.
Determine Your Budget
Whether you’re shopping for health insurance or helping your loved ones navigate the process, it’s important to start by determining how to get low cost health insurance.
You’ll want to consider routine and unexpected healthcare costs, including your premium, copays, and deductibles.
The federal online marketplace and many state marketplaces offer snapshots of these costs for each plan, making it easier to compare.
For example, if you’re shopping for an HMO plan, you’ll likely find that an in-network EPO (which doesn’t require referrals) or PPO (which typically does) has lower costs than a traditional HMO (which requires referrals to see specialists).
Another consideration is the cost of any prescriptions you may need, which can be relatively high. Then add in the price of office visits, if applicable.
If you choose an ACA plan, your deductible will also be part of this equation. You’ll also want to estimate how much you can pay in a year to reach your out-of-pocket max.
It is the highest amount you’ll be required to spend before your health insurance starts paying 100% of your healthcare expenses.
Once you know your maximum, putting monthly money aside to cover those unplanned healthcare costs is a good idea. It’s similar to budgeting for other bills, such as rent, food, and clothing.
Review Your Options
Selecting a health insurance strategy might be challenging. Whether starting a new job and choosing coverage for the first time, shopping during open enrollment at your current company, or purchasing a plan on your own, there are many options to consider.
Fortunately, there are resources to help you make the best choice for your healthcare needs and budget. Start by reviewing the options available in your area.
You can find plan summaries and information on your state’s insurance marketplace (if it has one), the federal marketplace, or through a broker or an insurance company directly.
Review the benefits offered by each plan. Look at each network’s list of doctors and hospitals and the cost-sharing options (like copays, deductibles, and out-of-pocket maximums).
Compare the costs for the types of care you’re likely to need to get an idea of what is reasonable. Also, consider whether a plan has a star rating and what that means.
It can be a good indication of a quality plan, though you should use this as a final step after considering all the other factors. Also, pay attention to the insurer’s financial stability, which you can find through an independent organization.
Make Your Decision
When you make your decision, it should be based on how important different factors are to you.
For example, if you anticipate spending a lot of money on medical care in the coming year, you might be better off choosing a plan with a higher sum insured, which will help you cover your anticipated costs.
However, a high sum insured will result in a higher premium, so you should weigh your options carefully.
In addition to considering your budget and comparing plans, you should also consider the type of network and provider choice you want.
The most common networks are health maintenance organizations (HMOs), preferred provider organizations (PPOs) and exclusive provider organizations (EPOs).
Point of service (POS) plans are a hybrid between an HMO and PPO, often requiring referrals to see specialists but allowing you to go out of network for some services.
Lastly, it would help to consider how the various plans will cover your prescriptions and which medications each plan has in its formulary.
This information is typically available on the online marketplace for each you are considering. If you are eligible for premium subsidies, you should also look at plan quality ratings based on how well each plan performs in areas such as cost and coverage of preventive care.
For instance, if you are considering a Silver plan and have a list of your preferred medical providers, you should also check whether those physicians are in-network with your plans.
In summary, when choosing a health insurance plan, it’s crucial to determine your medical needs and understand the costs and coverage offered by different plans. Consider your budget, including premiums, copays, and deductibles, and compare options to find the most suitable plan. Review the benefits, provider networks, and drug formularies of each plan. Finally, make a decision based on your priorities and ensure that your preferred healthcare providers are included in the plan’s network.