Shopping for health insurance is a big decision, but asking the right questions can make it a lot easier. When it comes to health coverage, everyone has different needs and preferences. Understanding the features of a health plan can help you pick the right match for you. Let’s start with the kind of plan you want. Is it important for you to see doctors out of network or without referrals?
If so, you may want to look into PPO plans. If it’s not a top priority, then you may want an HMO. You’ll pick a primary care physician to coordinate your care and get a network of providers to choose from trying to save money. Opt for a plan with a higher deductible that can be used with a health savings account to save tax free dollars for qualified medical expenses. Or look for a plan with a tiered network you’ll save when you visit certain doctors and hospitals.
This works best if your providers are already in the lowest cost tier or if you don’t mind switching. Once you figure out a plan type, you’re halfway there. Now you just have to figure out the best balance of cost and coverage. There are two main types of cost premium and out of pocket. Your premium is the monthly fee you pay to become a member of a health insurance plan.
When you need health care, your health insurer will pay a portion of your covered health care costs and you’ll pay the rest that’s the out of pocket costs. This is where the balance comes in. Think about it this way you pay your premium regardless of whether you use any service. But you only pay your out of pocket costs when you receive care. So if you see a lot of doctors, check the plans out of pocket costs and make sure it’s an amount you’re comfortable with.
If not, consider a plan with a higher premium so that the insurer covers a higher portion of the services you are likely to use. Find out if your plan has a deductible. This is a dollar amount you have to pay for services before your insurer starts to pay a portion of the cost. If you reach your deductible and still need more care, you and your health insurer will share costs until you reach your out of pocket maximum. If you reach your out of pocket maximum, then your health insurer will pay for all of your coverage services for the remainder of the plan year.
Also look into what services apply towards the deductible and whether it covers both medical benefits and prescription drugs. Most health insurance plans include prescription drug coverage, so if you use a lot of medications, make sure those drugs are covered. Also check if the pharmacy you use is in network and whether the plan has any special provisions, like a mandatory generic program. And if you need specialty pharmacy drugs, look into how your plan covers them. Don’t forget you can save on prescription drugs by taking advantage of generic drugs and mail order service.
Questions about making your health insurance decision?