Finding the right health insurance coverage for you and your family can be a tricky situation. There are many factors to consider, especially in 2017. With impending changes to current coverage, and the possibility of a brand new government implemented health care plan, choosing your insurance is more difficult than ever. If you are looking to find a new health insurance plan, follow the steps below, and make the process as easy on your stress level, (and your wallet), as possible.
Visit Your State’s Government Marketplace or Private Exchange
Most people get health insurance through an employer. If you’re one of them, you won’t need to use the government insurance exchanges, or marketplaces. If your employer offers health insurance and you still wish to search for an alternative plan in the marketplace exchanges, you can. But plans in the marketplace are likely to cost a lot more. Most employers that provide insurance pay a portion of workers’ premiums, so they’ll likely offer the least expensive option.
If your job doesn’t provide any affordable health insurance benefits, shop on your state’s Affordable Care Act marketplace, if available, or the federal marketplace to find the lowest premiums. You can also purchase health insurance through a private exchange or directly from an insurer. If you choose these options, you won’t be eligible for premium subsidies, which are income-based discounts on your monthly premiums.
Compare Plans and Premiums
Get ready to know your acronyms! The most referred to are HMOs, PPOs, EPOs, or POS plans. The kind you choose will help determine your out-of-pocket costs and which doctors you can see.
While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.
Here is a quick guide to make things a little easier for you:
- HMO: Health Maintenance Organization
- PPO: Preferred Provider Organization
- EPO: Exclusive Provider Organization
- POS: Point of Service Plan
When comparing different plans, make sure you are acutely aware of your family’s health needs. Though it’s impossible to predict every medical expense, being aware of what health needs your family already has can help you make an informed decision.
If you choose a plan that requires referrals, such as an HMO or POS, you must see a primary care physician before scheduling a procedure or visiting with a specialist. Because of this requirement, many people prefer other plans. POS and HMO plans may be better for you if you don’t mind your primary doctor choosing specialists for you. A benefit of this system is that there is less work on your end, since your doctor’s staff coordinates visits and handles medical records. If you do choose a POS plan and go out of network, make sure to get the referral from your doctor ahead of time to reduce out-of-pocket costs.
If you’d rather choose your doctors, you might be happier with a PPO or EPO. An EPO may also help you lower costs as long as you find providers in network; this is more likely to be the case in a larger metro area. A PPO might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out of network.
Compare Available Networks
Costs are lower when you go to an in-network doctor because insurance companies contract lower rates with in-network providers. When you go out of network, those doctors don’t have contracted rates, which costs you and your family health insurance company more money. If you have preferred doctors and want to keep seeing them, make sure they are listed in the provider directories for the plan you’re considering. You can also directly ask your doctors if they take a particular health plan.
If you don’t have a preferred doctor, you’ll probably want a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, since you’ll be more likely to find a local doctor who takes your plan. Eliminate any health insurance plans that don’t have local in-network doctors and those with very few provider options compared with other plans.
What Will You Be Paying Out of Pocket?
The sharing of various costs is a very important factor to consider. Any plan’s summary of benefits should clearly lay out 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. Cost-sharing options vary, so your goal is to narrow down choices based on out-of-pocket costs. A good rule of thumb to follow is that the lower your premium, the higher your out-of-pocket costs.
At this point, it is likely that you have narrowed your search for health insurance considerably. Check the summary of benefits to see which plans cover a wider scope of services. Some may have better coverage for things like physical therapy or mental health care, while others might have better emergency coverage. If you skip this quick but important step, you could miss out on a plan that’s much better tailored to you and your family.
Choosing the right plan for you and your family may seem overwhelming. But remember, you can always call one of the agents at Health Plans Depot with any questions that you may have about this often confusing process. Although it may seem like a great deal of work, remember that the health of you and your family is of the utmost importance.