If you need to choose health insurance but are feeling a little lost, take comfort in the fact that you’re not alone.
Between politics, changing laws, plan options, pricing brackets, and more, it can all seem like a jumbled mess. In the end, all we want is our health needs met and some insurance for potential emergencies down the line.
That’s why knowing specifically what to look for when choosing a plan is so important. Today, we’ll take a look at a few of the most important considerations you need to look at before insurance shopping!
Where Do You Choose Health Insurance?
Before considering a specific insurance plan to get, you need to know where to look in the first place.
If you’re a full-time employee for a company that offers health benefits, then you may already have your answer. Some employers offer health insurance plans at reduced rates and you buy into them through your company.
This can make choosing a health insurance plan easy, but it’s not the only way.
You also have the option to go through the federal government’s healthcare marketplace, which you can access via healthcare.gov. Even if your employer offers you a health insurance plan, it may not suit your needs or be at a price point you’re comfortable with.
In that case, you still have the option of shopping plans through the healthcare marketplace.
Finally, some places, such as a company like this, understand that people have varying needs that need to be met. For example, you may be in between jobs and only need a short-term insurance plan to cover you until your new plan takes effect.
Companies like Custom Health Plans specialize in helping people choose health insurance plans that are tailored for their specific needs.
Out-of-Pocket Expenses vs. Premiums vs. Deductibles
There are two main ways that you will pay for your health insurance, and it’s important to consider both when choosing.
Every month you will pay a certain amount of money to your health insurance company regardless of whether or not you have (or will) receive care. This is called a “Premium” and it’s basically the amount of money it costs you to have access to healthcare in the first place.
When you receive care, such as a check-up visit with your primary doctor or a visit to a specialist, you will pay a sum of money. This is called an “out-of-pocket expense” and it can vary greatly depending on:
- Your plan
- Your doctor
- The specifics of the visit and/or care received
Finally, a deductible is the amount of money you need to spend before your plan kicks into effect and your health insurance will pay for everything after. For example, if you have a $1,000 deductible and one doctor’s visit costs $1,000 your deductible is met and any future visits are fully covered.
If you’ve been wondering “What health insurance should I get?” then money is probably a top priority for you. You need to weigh out-of-pocket expenses, premiums, and deductibles for each plan available to you.
Maybe you don’t want to pay very much money every time you receive care (or any at all). That may mean that you have to pay larger sums of money for premiums.
On the flip side, you may be willing to pay more for each doctor’s visit just so you can save money on premiums.
In general, if you have pre-existing conditions or know you will receive medical care often, you may want to opt for larger premiums. If you are healthier and only want to cover emergency needs, it might be smarter to save money on premiums and pay more out-of-pocket.
Consider the Network
In the insurance world, a “network” is a group of healthcare providers, hospitals, physicians, etc. that have agreed to offer reduced rates within said network.
When a particular doctor is outside of the network for your insurance plan, it doesn’t mean that you can’t use them, but it may cost you more. It’s important to consider networks when you choose health insurance to know if you’ll be covered.
If you have a doctor that you prefer as your primary physician, or if you have a specialist that you know you need to visit often, ask what networks they use. This will help you pick a plan that works alongside your preferred hospitals, physicians, and more.
Sorting Health Insurance Types
Now that you’ve considered a few important aspects of health insurance plans, you need to decode the different types of insurance.
Generally speaking, there are a few different classes of health insurance that may often be referred to by their acronyms, including:
- HMO (Health Maintenance Organization)
- PPO (Preferred Provider Organization)
- EPO (Exclusive Provider Organization)
- POS (Point of Service Plan)
These differ in a few important ways.
Network
If you don’t want to be locked within certain networks (see above), then you should consider PPO and POS. Out-of-network care may be more expensive, but you at least have the option of leaving the network.
Referrals
HMOs and POSs require you to get a referral from your primary physician in order to receive care from a specialist, such as an optometrist for contact lenses. If you don’t want to have to go through this, then look at PPOs and EPOs.
Out-of-Pocket Expenses
HMOs and EPOs have lower out-of-pocket expenses for each visit, but they come with their own drawbacks. Namely, you’re limited in the number of providers you’re able to receive care from.
A Note About Metals/Medals
You may notice that some insurance plans are classified as bronze, silver, gold, etc. You may think that the “higher” you go (gold > bronze) the more quality healthcare you receive.
This is not true. You will not receive better quality healthcare services for choosing a higher tier plan. Instead, these tiers only dictate the specific quirks of the plan, some of which we’ve outlined here for you.
Making the Right Decision for Your Health
Healthcare is a crucial aspect of our daily lives, but when you need to choose health insurance plans it can get confusing fast.
There are a few key factors that you need to consider before you go shopping, including premiums, out-of-pocket expenses, networks, etc. With these aspects in mind, you should be able to narrow your choice down considerably.
If expensive medical bills are a hurdle in your life, check out some great savings tips to help you prepare for future medical emergencies!
