How to get Great Value Health Insurance: Your Step-by-Step Guide
Find out how to choose the best coverage by learning about different health plans and comparing the expenses paid out of pocket.
In most cases, you have a limited amount of time to find the finest health insurance policies for your family, but choosing the incorrect coverage because you were in a hurry may be very expensive. The following is an all-encompassing guide that can assist you in locating reasonably priced health insurance, whether from a state or federal marketplace, an employer, or any other source.
Step 1: Choose your health insurance marketplace
The health insurance plans that are accessible to you will determine how you go about shopping for insurance.
If the employer you work for provides health insurance
Most of the people who have health insurance do so through their employment. Unless you hunt for an alternate plan, you will not need to utilize the government insurance exchanges or marketplaces if your employer provides health insurance. However, market-based plans are probably more expensive than those provided by employers. This is because most businesses contribute to employee insurance costs.
If your employer doesn’t offer health insurance
You may search the online marketplace for your state, if it is offered, or the marketplace run by the federal government to select the most suitable plan. You can let us find the perfect plan for you easily right here. Or you can use the government website HealthCare.gov and input your postal code there. You will be sent there if there is an exchange in your state. In such a case, you will have to use the federal marketplace.
You also have the choice to buy health insurance via a private exchange or buy it straight from an insurance company. If you choose this route, you will not be eligible for premium tax credits, which are reductions in your monthly premiums calculated according to your monthly income.
Step 2: Compare types of health insurance plans
When looking for the optimal health insurance policy, you are going to run across a whole lot of acronyms. HMOs, PPOs, EPOs, and POS plans make up the majority of the market share for health insurance coverage. Depending on your option, your out-of-pocket expenses and the physicians you may see will differ.
Look for a summary of the benefits
Online marketplaces will often include a link to the plan's summary of benefits, which details all the prices and coverages associated with the plan. There should also be a provider directory that can be accessed, which details all of the medical clinics and services that are part of the plan's network. If you are getting your insurance via your employer, you should contact the benefits administrator at your place of business for a summary of the coverage.
Weigh your family’s medical needs
Take a look at the length of treatment you have had in the past and the kind of treatments you have received. While it is hard to anticipate all the costs associated with medical treatment, being aware of patterns may help you make an intelligent decision.
Consider whether you want a referral system of care
Plans that require referrals
Before making an appointment to see a specialist or arranging a treatment, you are generally required to contact your primary care physician if you have an HMO or POS plan, both of which ask for recommendations. Many individuals would rather go with a different strategy because of this prerequisite. However, since they restrict your options to just those providers with whom they have agreements, HMOs are often the least expensive health insurance.
One main doctor is supervising your comprehensive medical treatment under HMO and POS plans, which might result in better familiarity with your requirements and continuity of your medical data. This is one of the benefits of these types of plans. To cut down on the amount of money you have to pay for care not covered by your insurance, be sure to seek a referral from your primary care physician before going to a specialist in your network. (With an HMO, you are not allowed to see a doctor outside your network unless there is an emergency.)
Plans without referral requirements
If you prefer to visit specialists without a referral, an EPO or PPO can be a better option than a traditional health insurance policy. (EPOs normally do not need a reference, but some read the small print.) An EPO may help keep prices low as long as you identify doctors who are part of the EPO's network; this is more likely to be the case in big metropolitan areas. If you reside in a distant or rural region with limited access to physicians and services, a PPO could be better than an HMO since you may be compelled to go to a provider not part of your insurance network.
What about an HDHP with a health savings account?
A high-deductible health plan, also known as an HDHP, may be any of the health insurance described above, including HMO, PPO, EPO, or POS; nevertheless, it must adhere to specific guidelines to be considered "HSA-eligible." The premiums for these HDHPs are often cheaper, but the out-of-pocket payments are typically greater, particularly when you initially enroll. They are the only plans that allow you to form a health savings account, also known as an HSA, which is an account that offers favorable tax treatment and may be used to pay for medical costs. Be careful to understand yourself about HSAs and HDHPs before considering this arrangement if you have any interest in participating in it.
Step 3: Compare health plan networks
The medical providers and facilities your health insurance "network" has negotiated with to provide you with treatment are referred to as "network" providers and facilities.
Why is it important to have a network?
When you visit a doctor who participates in your insurance plan's network, you will have reduced out-of-pocket costs since insurance companies negotiate cheaper rates with the doctors and hospitals. If you go to a doctor not part of your insurance network, that physician will not have predetermined fees, and you will normally be responsible for paying a greater proportion of the total cost.
Do you have any doctors that you like?
Make sure that the medical providers you are currently visiting are included in the directory of doctors and hospitals associated with any plan you are considering purchasing. You might also inquire directly with your doctors to determine which health insurance plans they accept.
Do extensive networks matter?
If you do not already have a primary care doctor you see regularly; it is a good idea to seek a health insurance plan with a big network of doctors. This will give you more choices. If you live in a remote area, having access to a bigger network is very significant since it will increase the likelihood that you will be able to locate a nearby doctor who participates in your particular healthcare plan.
If feasible, you should remove plans that do not offer local in-network doctors. You should also consider eliminating plans with extremely limited provider alternatives compared to comparable plans.
Step 4: Compare out-of-pocket costs
Out-of-pocket costs, often known as charges that are not included in your monthly premium, are another important factor to consider. The summary of benefits that come with a plan has to make it abundantly apparent how much money you will be responsible for paying out of pocket for services. Many of the state online markets, as well as the federal online marketplace, provide snapshots of these prices for comparative purposes.
Know your health insurance terms
It is helpful to have a working knowledge of the following essential terms related to health insurance:
- Copay: When you obtain healthcare or service, you will be required to pay this one-time, flat price, which might be as much as $20 USD.
- Coinsurance: This is the percentage (for example, 20%) of a medical bill that you are responsible for paying; your health insurance policy will cover the remaining costs.
- Deductible: Before your insurance begins to pay for covered medical services, you must pay this amount.
- Out-of-pocket maximum: This is the most money you will spend on your own health care in a year. Once you have used up this limit, your insurance covers the remaining balance.
- Out-of-pocket costs: Copays, coinsurance, and deductibles are all additional expenses you have to pay for a plan.
- Premium: This is how much you pay each month toward your health insurance.
Higher premiums, more coverage
The greater your premium, the smaller your out-of-pocket payments will be, including your deductible, copay, and coinsurance (and vice versa). If any of the following apply to you, it may be in your best interest to choose a health insurance plan that reimburses you for a higher percentage of your overall medical costs:
- You have a doctor's appointment with either your primary care physician or a specialist.
- You are often in need of urgent medical help.
- You regularly put a significant dent in your bank account by purchasing pricey or branded prescriptions.
- You either already have young children or intend to have a baby shortly.
- You are scheduled to have surgery very soon.
- You have been told that you have an illness that will need ongoing treatment, such as cancer or diabetes.
Lower premiums, higher out-of-pocket
If any of the below apply to your scenario, selecting a plan with lower premiums and co-payments but lower monthly premiums might be the best option.
- You cannot pay the higher monthly premiums for a plan with lower out-of-pocket payments because of financial constraints.
- You rarely go to the doctor since you are in excellent health.
Step 5: Compare benefits
You should be able to reduce the number of available plans to only a handful by the time you reach this stage. After that, here are some things to think about:
Check the scope of services
Refer to that list of benefits to see which of the plans includes a more comprehensive range of services. Some people may have superior coverage for physical therapy, reproductive treatments, or mental health care, while others have better coverage for emergencies.
If you neglect this easy but essential step, you risk missing out on a plan far more suited to you and your family's needs than other options.
Address any lingering questions
In some cases, the easiest way to address your questions could be to give the customer support number for the plan a call. Prepare your questions in writing in advance, and make sure you have a pen and electronic recording device on hand to take notes on the responses.
The following are some examples of possible questions for you to ask:
- I am now taking a certain drug. In what ways does this plan cover the cost of that medication?
- Which medications do I need to treat my ailment are covered by this plan?
- What kinds of maternity care are covered under this plan?
- What should I do if I get ill while traveling in another country?
- How can I get started with the registration process, and what kinds of papers do I need?
Summary: How to choose health insurance
Here’s a quick recap:
- Visit the online health insurance marketplace, where you may explore all the plans available to you.
- Determine if you want a health insurance plan that is suitable for an HSA and choose between a health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO), and point of service (POS).
- Remove from discussion any plans that do not include your chosen physician or that do not include local physicians as part of their provider network.
- You need to decide if you want greater health coverage but higher premiums or cheaper premiums but higher out-of-pocket expenditures and then go from there.
- Ensure that the plan you choose will cover the routine and essential medical care you need, such as medications and visits to specialists.