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In the United States, approximately 11.1 percent of people under the age of 65 do not have health insurance.
Are you part of this group? Are you unsure of how to choose between the different types of health insurance plans? Are you confused by all your options?
If any of these questions resonate with you, remember that it’s not as hard to choose a comprehensive health insurance plan as you might initially think. Listed below are some tips that will help you to find a plan that is affordable and gives you (and your family) the coverage you need.
Learn the Basics
Before we dive into some specific factors you’ll need to consider when shopping for health insurance, it’s important to make sure you have a grasp of the basics. Here are some essentials that everyone ought to know when looking for a healthcare plan:
Metal Categories
Health insurance plans are broken up into four different “metal” categories. They are as follows:
- Bronze
- Silver
- Gold
- Platinum
As you can probably guess, a platinum plan is going to provide more coverage and benefits than a bronze plan. It’ll also be more expensive.
Total Healthcare Costs
There are a few different expenses that you’ll need to consider when shopping for health insurance. First of all, there’s the premium. This is the monthly cost that you pay to your insurance provider, regardless of whether or not you used any medical services that months.
There are also out-of-pocket costs to take into account. This includes your deductible, which is the amount that you have to pay before your benefits kick in. You should also understand co-pays, the flat fee that you pay when you receive healthcare services, and co-insurance, which is the percentage of healthcare costs that you continue to pay even after your deductible is met.
Types of Plans
Make sure you know the difference between various types of insurance plans, too. Here are some of the most popular plan types for which you might sign up:
- EPO: Short for Exclusive Provider Organization, this plan only covers services provided by healthcare professionals who are part of a specific group (or network) unless it’s an emergency
- HMO: Short for Health Maintenance Organization, this plan is similar to an EPO, but it might also require you to work or live in a specific service area
- POS: This plan allows you to see doctors in and out of your network, but you’ll pay less if you receive treatment within your network; you also need to get a referral from a primary care physician if you want to see a specialist
- PPO: This plan also allows you to pay less if you see a doctor within your network; you can see other providers without a referral, but you’ll have to pay more out of pocket
There are other types of plans that you might want to consider, but these are the most well-known options.
Tips for Choosing a Health Plan
Okay, now that you have an understanding of the basics, it’s time to dive into the specific factors you ought to keep in mind when you’re comparing different health plans. Outlined below are some of the most important things to consider to ensure you get comprehensive coverage without having to spend an arm and a leg:
Choose Your Marketplace
One of the first things to think about when you’re looking for a new insurance plan is your marketplace (the place from which you’re going to purchase insurance coverage).
If you’re not getting health insurance through your employer (which likely isn’t the case if you’re reading this article), you can look into purchasing a plan through your state’s marketplace or the federal marketplace. To do this, start by visiting HealthCare.gov and entering your zip code during the annual open enrollment period (November 1 to December 15). Through the website, you can shop for plans and compare premiums, benefits, etc.
You can also buy health insurance directly from a provider or through a private exchange. You won’t get to take advantage of the tax credits that come with shopping through the state and federal marketplaces, but this is still a viable option (although it will likely be more expensive).
Choose the Type of Plan You Want
Once you’ve decided where you’re going to be shopping for health insurance, the next step is to decide which kind of plan you want.
Start by thinking about you and your family’s needs. How much treatment have you received in the past? What do your typical healthcare expenses look like?
Answering these questions can help you to get a sense of how much coverage you need. For example, you might also want to choose a cheaper plan, like an HMO, if you need to save money but still want coverage.
Some people shy away from these plans because they require you to see a primary care physician before you see a specialist. However, the inconvenience might be worth the money you save, especially if you don’t anticipate needing to see a specialist very often (if at all).
For those who don’t want their primary care physician to choose their specialist, a PPO or EPO plan is likely a better fit. With EPO plans, though, you need to make sure you’re staying within your network. This can be hard to do if you live in a rural area and don’t have access to a wide range of healthcare practitioners.
Compare Networks
Speaking of networks, be sure to compare networks before selecting a particular healthcare plan. Comparing the networks will help you ensure you have plenty of providers to choose from and aren’t limited based on where you live.
Do you already have a doctor with whom you enjoy working? If so, you make sure the provider you’re thinking about purchasing a plan has included them in their network.
Pay special attention to the size of the network if you live in a rural area. A large network will be particularly beneficial to you since it gives you plenty of options to ensure you get the care you need and don’t have to make sacrifices based on limited choices.
Compare Out-of-Pocket Costs
Take note of the out-of-pocket costs associated with each plan you’re considering. What are the monthly premiums? How much is the deductible?
Keep in mind that plans that come with a lower premium tend to also come with higher out-of-pocket costs. This doesn’t always have to be a dealbreaker, though. Some people are willing to exchange higher out-of-pocket costs for a lower monthly premium, especially in the following cases:
- You’re in good health and don’t have to see the doctor very often
- You have a low income and can’t afford high monthly premiums
In other situations, it might be in your best interest to pay more money for a plan with lower out-of-pocket costs. Here are some examples:
- You often require emergency care
- You take expensive or brand-name medications
- You’re expecting a baby or have plans to get pregnant soon
- You have small children
- You have a planned surgery in the near future
Those who suffer from chronic health conditions, such as cancer and diabetes, also often fare better when they opt for a plan that has higher premiums.
Compare Benefits
Next, take note of the benefits that each plan offers. What medications does each plan cover? What kind of maternity services does it offer?
Consider whether specific services like physical therapy, mental health care, or fertility treatments are covered, too. If you often need to go to the emergency room, you might also want to look for a plan that includes good emergency coverage.
If It’s too Good to Be True, It Probably Is
Be wary of healthcare plans that seem too good to be true. There’s usually a catch.
For example, some plans came under fire earlier this year because they boasted $0 deductibles. The catch, though, was that there was a $1,000 per day copay for spending time in the hospital. If you didn’t read the fine print, you could end up with a pretty hefty bill in the event that you had to go to the hospital for an extended period of time.
Ask a Professional for Assistance
Don’t be afraid to work with an insurance agent, like those who work at Medicare Wire, during the shopping process. If you’re confused or unsure of which plan to choose, you can ask them questions and get insights from an expert. This will help you enusre you’re not overlooking anything important, too.
Pick a Comprehensive Health Insurance Plan Today
If you keep these guidelines in mind, you’ll have no trouble finding a comprehensive health insurance plan that works for your needs and budget. Now that you know how to sift through your options and choose an optimal health plan, it’s time to start shopping!
Do you want to learn more about health insurance or managing your health in general? If so, we have lots of other articles available on our site. Check out the health section of our site today for more information.
