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How to Pick a Health Insurance Plan

Choosing a health insurance plan is not a very simple task. Several people spend days researching on the plans and yet, remain uncertain if they have selected the perfect plan. As per the experts, choosing a health insurance plan is tricky, if not complicated. However, 3 things can help you in this process. Let’s take a look at them –

Choose the Correct Category

Commonly, Health insurance companies categorize their plans based on various combinations, that might include the cost, network and other criteria. An example of categories of these plan could be: Bronze, Silver, Gold, and Platinum. These categories will show you the cost of the plan, things that are included in it, and things that aren’t. The plan categories have nothing to do with the quality of care you will receive. However, as you tier up from one category to another, the premium amount will rise accordingly.

How to Pick a Health Insurance Plan

Calculate the Total Healthcare Cost

As you are selecting a health insurance plans, you should keep the following things in mind:

  • Monthly Premium: you need to pay a monthly bill (premium) to the insurance company, even if you do not use any medical services for that period. The monthly premium is calculated based on various things
    • Your age and gender
    • Your employer group premium price (if you are getting insurance through your employer)
    • Your city, state and often the county you live in
    • Lastly, if you are selecting an individual or family plan
  • Annual Deductible and other out of pock costs: Every insurance plan comes with certain out of pocket costs. Annual Deductible is one of the biggest out of pocket cost when it comes to your healthcare cost. You should keep in mind as you are selecting an insurance plan that you will have to pay that entire annual deductible before insurance will pay for your health care services. These annual deductibles could range from $250 a year to $6,000 a year for an individual and in some cases up to $12,000 for a total family deductible.
    • One thing to remember, you don’t pay this annual deductible to insurance, rather, you pay this deductible amount to the doctor’s office as this is your out of pocket cost. So, when you receive a bill from your doctor’s office, and it says “your portion or your responsibility” that amount will have to be paid to the doctors.
    • 80/20 rule: Most health insurance plans have 80/20 rules, which means, when you have met your annual deductible, insurance will cover up to a certain amount of your healthcare cost. This % is most commonly divided as 80% covered by the insurance and 20% will be your responsibility.
  • Healthcare Cost and your Health: As you are choosing your health insurance plan, you should keep in mind your overall health needs. If you have multiple healthcare conditions and you visit doctor often, then getting choosing a plan that has less deductible (this will have a higher monthly premium) might be a better idea since you will meet your annual deductible sooner and then insurance will pay for your health care cost.
  • Self-pay Patients: A little research can help you save significantly when it comes to the cost for your healthcare. There are many doctors, surgeons and other specialists who offer their services for a cash price. This cash price is usually a lotless than the insurance price. SINCE you have to pay your deductible out of pocket, you might as well ask for a cash price and pay less. You can always ask the doctor’s office for your visit notes and submit those notes to insurance along with the receipt you paid. This will help you get credit towards your annual deductible.

Know the Plan and Networks:

While some plans allow you to use most of the doctors and health care facilities, others will charge you more if you visit providers outside the network. There are 4 types of networks –

  • Health Maintenance Organization (HMO):Generally, limits the coverage to doctors who are in contract with the organization. These plan might restrict you to live or work within their service area to be eligible for coverage.
  • Preferred Provider Organization (PPO): This plan creates a network of providers by making a contract with doctors and hospitals. If you choose a provider within the network, you pay less. Else, you have to pay out of network prices.
  • Point of Service (POS) Plans: You pay less if you opt for doctors or hospitals within the network. However, to see a specialist, you’ll need to get a referral from your primary care doctor.
  • Exclusive Provider Organization (EPO) Plans: As the name suggests, services are restricted to the hospitals and doctors within the network except for the case of an emergency.

These 3 things will surely help you narrow down your search for health insurance plans, and will ensure that you make the best out of the tricky situation.

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