Choosing the right health insurance plan is not easy. There are various factors to consider. You must compare costs, coverage, and other features.
A firm understanding of the variables involved in health coverage will help you determine which plan is right for you. This article will review what’s involved in a health plan so you can make an informed decision.
Compare Coverage
Most health plans cover essential health benefits which include the following:
- Emergency services
- Hospitalization
- Prescriptions
- Mental health services
- Rehabilitative services
- Doctor visits
- Preventative wellness and disease management
- Lab testing
- Pediatric services
- Maternity and newborn care
Your basics will be covered, but what about additional services like vision, dental, hearing, and alternative therapies? Some insurance plans will offer this coverage, but they may be more expensive. You must consider which plan is best suited to your needs based on your budget and medical issues.
Consider the Plan Type
There are four main types of insurance plans to choose from. They vary in referral requirements, costs, and your freedom to choose a provider. Here’s a brief breakdown of each.
- HMO (Health Maintenance Organization): An HMO will require you to use a network provider unless it’s an emergency. Most specialist visits will require referrals. The plans offer lower out-of-pocket costs, but less freedom in choosing providers.
- PPO (Preferred Provider Organization): A PPO will cover care from an out-of-network doctor, but in-network care will be less expensive. It will not require referrals for specialist visits. However, the plans come with higher out-of-pocket expenses.
- EPO (Exclusive Provider Organization): An EPO will require you to use an in-network doctor except for emergencies. Most specialist visits will not require a referral. The plan offers lower out-of-pocket costs and limited provider choices.
- POS (Point of Service Plan): A POS will cover you for out-of-network visits, but the care will be more expensive. It does not require specialist referrals. It is a low-cost option but offers limited in-network providers.
Learn more in our article Your Managed Care Options: HMO, PPO, EOS, or POS.
Consider Out-of-pocket Expenses
There are several out-of-pocket costs to consider when choosing a health insurance plan. They include:
- Premium: The premium is the amount you will pay each month for your health insurance.
- Copay: The copay is a flat fee the member pays for most medical needs, including doctor visits, prescriptions, and procedures.
- Deductible: The deductible is the amount you pay for your medical care before your insurance kicks in. For example, if your insurance plan has an annual $2500 deductible, you won’t receive coverage until you’ve paid $2500 per year in medical bills. However, some services may be covered automatically.
- Coinsurance: Patients will be required to pay coinsurance after reaching their deductible and before the out-of-pocket maximum is reached. Coinsurance is charged as a percentage of your medical bill, typically between 20% and 40%. So, if you have a $100 health expense and your coinsurance is 30%, you must pay $30 for the care you receive. Most plans have both copays and coinsurance. Some have neither.
- Out-of-Pocket Maximum: The out-of-pocket maximum is the most you will pay in insurance per year. After you reach your out-of-pocket maximum, your insurance plan will cover the rest of your costs.
Learn more about these costs in our article How Do Deductibles, Coinsurance, and Copays Work?
Generally, the more out-of-pocket expenses you pay, the more coverage your plan offers. You should choose a high-premium plan with more coverage if you have significant medical needs. Choose a low coverage low premium plan if you are in good health and rarely require medical care.
Rewards and Incentives
Insurance plans may offer rewards and incentives to promote sign-ups and loyalty. Examples include:
- Wellness Programs: Wellness programs encourage members to engage in healthy behavior. They provide guidelines for healthy diet, exercise, and lifestyle choices. They may offer rewards in the form of cash or gift cards to members who reach their wellness goals.
- Discounts: Health insurance plans may offer discounts on wellness-related items like gym memberships and smoking cessation programs.
- Travel Discounts: Some health insurance providers will offer discounts on trips and accommodations if a member needs to travel for medical reasons.
Rewards and incentives could make a difference when choosing a plan.
Get Your Online Health Insurance Quote Today
The world of health insurance is not easy to navigate. Insurance Broker Hub simplifies the process by providing insurance quotes in one place making it easy to compare plans. Fill out our secure form to get started today.
