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Picking Out a Health Insurance Plan that is Right for You and Yours

July 17, 2018 | By Mason Roberts

Because of the high cost of health care, it is pretty much a necessity for everyone to have health insurance coverage. As such, it is important to select your health insurance carefully, because the insurance landscape offers a variety of policy options that differ in coverage, cost, and deductibles. With so many options available, it is extremely important that you choose your coverage based upon your personal needs, Affordable Care Act marketplace. Go to the government healthcare site and enter your zip code. If your state displays in green, you can use the state exchange; otherwise you’ll use the federal marketplace.

Be Sure to Compare Plan Types

Health insurance policies, like people, come in all sizes and shapes. Health Maintenance Organizations (HMOs) are very common across the insurance landscape. HMOs require you to use health care providers within their network, and typically require a referral from your primary care physician in order to be covered for the services of a specialist.

Preferred Provider Organizations (PPOs) are another option. PPO health insurance utilizes a network but doesn’t limit you to in-network care, although it’s typically cheaper to use network providers and referrals aren’t required to see a specialist.

Exclusive Provider Organizations (EPOs) are a blend of HMOs and PPOs. Your coverage requires you to use providers within a network, but you won’t need referrals to see specialists. Finally, Point of Service (POS) plans are the least common option and are pretty much the direct opposite of EPOs. There is no limitation to the POS network; however, specialist referrals are required.

In summary, HMOs and EPOs are typically less expensive than PPOs and POSs with equal levels of coverage. It is worth considering that if network coverage in your area is lacking or you don’t feel comfortable with existing network providers, the higher cost of PPO or POS coverage may be worth the added expense.

Decide if You Want a Lower Monthly Premium or a Lower Annual Deductible

If you’re young and fairly healthy, you probably want to minimize your monthly premiums while still receiving comprehensive coverage to be utilized for an unforeseen accident, surprise illness, or change in health circumstances. Keep in mind that the less you pay up front, the higher your annual deductible will be, resulting in more out-of-pocket costs for you. Additionally, a less expensive plan may limit your selection of doctors or networks.

Consider Your Out-Of-Pocket Costs

In any insurance plan, it’s important to know how costs are shared between you and the insurer. Benefit summaries should clearly state what you must pay for specific services. Your annual out-of-pocket expenses are limited and should be specified in your coverage information. The rule of thumb is that the lower your premium, the higher your out-of-pocket costs.

Consider your options. A plan with higher monthly premiums that pay more of your medical expenses may be preferable if:

  • You have frequent doctor visits.
  • You regularly take costly or brand-name medications.
  • You anticipate a surgery in your future.
  • You have children or plan to have children.
  • You often seek emergency care.
  • You’ve been diagnosed with a chronic condition.

A plan with lower monthly premiums and higher out-of-pocket costs may be preferable if:

  • The premiums for a plan with lower out-of-pocket costs will strain your budget.
  • Your health is good and your doctor visits are infrequent.

Be Sure to Compare Plan Benefits

Assuming you’ve narrowed down your plan choices, it’s time to compare the benefits offered by each plan. It’s a good practice to write down any questions that you wish to have answered so that everything important to you can be addressed. To obtain answers, you can often go to the insurance carrier’s website, or contact one of their customer service representatives.

The following are typical question types when comparing plan benefits, though your questions may vary:

  • I have a chronic disease for which I take certain medications. Are they covered under your plan and how?
  • I frequently travel internationally. How am I covered when traveling abroad?
  • We plan on starting a family soon. What do you cover in terms of maternity services, both pre and post?
  • I have some pre-existing conditions. How are they covered, and what documentation do you require to prove previous coverage?
  • What is the process for signing up with your plan, and what documents must I provide?

Health insurance is certainly important, but we all know that there are times when the best of insurance doesn’t cover everything. For those occasions where you might need some temporary help to get through a financial bump in the road, you may want to explore the many benefits of installment loans. They offer fast access to emergency cash, and the flexibility to repay over time.