Before purchasing an individual health plan from either your employer or independently, there are a number of important questions you need to ask yourself before making your choice.
Your coverage should meet the needs of you and your loved ones and have an affordable monthly premium. Understanding what the policy covers and costs is also key, while knowing which plan type to select can have a dramatic effect on out-of-pocket expenses and monthly premium costs.
1. What type of plan is it?
Finding a plan tailored to your individual needs is key when selecting health insurance coverage. Different plan types offer various degrees of medical coverage, doctors available and out of pocket costs; there’s sure to be something right for everyone out there!
Insurance companies create plans based on their understanding of risk and what is within their means to offer, collecting premiums from many enrollees to cover any care that might be needed due to illness or injury.
Most health plans feature a deductible, which is the amount you must pay out-of-pocket before sharing costs with insurance. Deductibles help keep costs lower for people who rarely need medical services and prevent too many unhealthy people from signing up for expensive policies.
Some health plans only provide coverage when you use medical providers who belong to their network, for instance preferred provider organization (PPO) plans typically cover more medical care when you visit doctors and hospitals that belong to the PPO than with exclusive provider organization (EPO) plans.
Other health plans may place restrictions on how much they pay for out of network services, typically managed care plans such as HMO or EPO plans. An open access HMO, however, allows patients to go out-of-network for non-emergency care for an additional fee.
Every type of health plan comes with its own rules and arrangements for providing medical care, though all must cover the ten essential health benefits. When shopping on the marketplace for plans, it is essential to understand their operations so you can select one best suited to your situation.
2. What does the policy cover?
When shopping for health insurance, it’s essential that you understand exactly what coverage the policy offers. Be sure to inquire about its deductible, co-insurance and out-of-pocket expenses as well as which hospitals it covers in its network. Inquire if your plan provides for pre/post hospitalization charges or medication coverage as these could be important issues for you.
Your plan should also provide an overview of covered services, exclusions or limitations that might exist as well as estimated annual costs associated with them. Be mindful of how often you visit a doctor’s office or need prescription drugs since this could add up quickly.
If you want a comprehensive plan, be sure to inquire whether your insurer offers additional benefits such as vision and dental coverage. These may incur an extra premium, but if you have specific needs that can’t be covered without assistance it might be worth exploring this route.
An important consideration when selecting an insurance provider is their claim settlement history, as this will give an idea of their reliability as well as whether or not they honor claims.
Most people purchase health insurance during Open Enrollment or after experiencing a qualifying life event; however, a short-term plan can be purchased any time throughout the year at significantly less expense than an exchange plan; these plans typically cost 54% less and are useful when uncertain whether you qualify for permanent plans or don’t have enough money for expensive exchange plans; they typically last anywhere between three months to 364 days.
3. How much will I have to pay?
Your cost for health insurance depends on a number of variables. Some of the key ones include: 1. Type of plan. Whether it is through an employer plan, on the marketplace, or with an individual policy will ultimately determine how much you owe in premiums.
2. Deductible and coinsurance amount. Depending on your budget, selecting a plan with higher deductibles and lower copays could be advantageous; or vice versa. Additionally, be sure to consider the cost of prescription drugs; many plans offer drug lists (also called formularies) detailing which drugs they cover at what prices. You could also inquire at your pharmacy as to whether there are discounts available for certain brands of drugs.
3. Make sure your preferred physicians are in the plan’s network. Each plan provides a list of providers and health care centers within their network that are typically less costly to visit than out-of-network physicians, so before signing a plan it is a good idea to verify if all your preferred doctors are included on that list.
4. Your total out-of-pocket limit. Before signing up for health insurance, it’s essential that you understand how much of an out-of-pocket payment you must make every year in order to budget accordingly and determine which premium plan can fit within your budget. Depending on your income level and eligibility for cost sharing reductions (CSRs), cost sharing reductions could help lower out-of-pocket expenses significantly.
Make sure that the plan covers preventive services, like vaccinations and wellness visits for young children or if there is a family history of disease in your family. If the plan does not include these preventive services, consider purchasing separate health insurance policies to cover them separately.
4. How much can I afford?
No matter if it is through an employer-sponsored plan or the health insurance marketplace, be sure to consider your needs and budget when selecting an insurer plan or individual coverage. In addition to monthly premium payments, determine how much out-of-pocket expenses (like copays and deductibles ) you can afford upfront; paying more upfront means lower premium payments over time.
Your choice of specialists and medications will have an effect on the out-of-pocket costs associated with healthcare coverage. Before buying a plan, be sure to verify if these providers and prescription are covered. For this information you may contact an insurance provider or review their provider lists online.
An additional factor to keep in mind when making a healthcare plan selection decision is how often you expect to need medical services over the coming year. If your expected medical costs will be significant, a plan with a higher deductible might save money on monthly premium payments; otherwise a plan with lower deductible might prove more cost effective as visits and prescriptions will cover their share once that threshold has been reached.
Whenever seeking medical assistance, it’s crucial that you can access it whenever and wherever it may be necessary. What would happen if, say, your primary care doctor was no longer part of a network that offered specialist access or emergency illness treatments? For this reason, selecting a plan which allows access to trusted physicians and hospitals even when traveling can provide added peace of mind.
5. Do I want flexibility in choosing certain specialists or services?
Your choice of insurance plan can have a significant effect on cost. Some plans may exclude certain providers or treatments you prefer, so it is wise to do some research first and ensure they are part of a network before selecting a policy. Also take into consideration how often you expect to see doctors; if frequent visits to specialists (dermatologists, therapists or orthopedic surgeons for example) are in your plans’ future, make sure these visits don’t require referral from primary care physicians if that’s your plan of choice.
Budget for new insurance policies will also need to be determined. A health insurance agent can help you determine how much coverage is within your means by asking questions about age, location and health history (if purchasing an ACA plan). They’ll then explain various options and costs to you.
When purchasing outside the Affordable Care Act Marketplace, it’s essential to do your homework on the insurer. Check their history, read customer reviews and investigate their reputation; and it would be prudent to avoid policies with suspiciously low premiums that seem too good to be true.
As much as it’s impossible to accurately anticipate all your medical expenses each year, you can have an idea of your estimated costs such as monthly prescription drugs, chronic condition visits and any planned procedures or purchases. Furthermore, be mindful of your deductible and co-pay amounts; these are the costs you must cover prior to insurance company payout. If your out-of-pocket costs are substantial it might make sense to opt for a plan with higher deductibles and lower co-pays.
