Among the reasons why you should invest in health insurance at a time like this, is its health benefit as well as acting as a form of security. Since there are comprehensive healthcare plans available on the market, picking the right one can be cumbersome. In this article, we will help you with the best strategies for determining the right healthcare plan for you and your household.
- Determine Which Types of Health Insurance Plans are Available
The first step is learning the various health insurance types that are available before making an attempt to select one. A variety of plans in terms of coverage, networks, and costs can be expected in each of the plans. Below is a brief summary of the most normal plans you would most likely encounter:
Health Maintenance Organization (HMO): You have to designate a primary care physician (PCP) and get referrals to see specialists. Generally, the plans that are offered have lower premiums but you are required to use particular providers only.
Preferred Provider Organization (PPO): A greater restriction is not placed on you for the providers, and it is not obligatory to get a referral to a specialist. However, as always, PPO plans are higher in premium costs.
– Exclusive Provider Organization (EPO): Easier than HMO as there is no requirement to go seeking for referrals. Provides a network within which one must seek services.
– Point of Service (POS): Covers the most aspects of both HMO and PPO plans. Some specialists may require a referral while people may seek more providers outside the network than one specialist.
2: Evaluate Your Health Needs and Available Finance
Determining the type of health plan appropriate for you will require an understanding of not only current needs but also your financial condition. Answer the following questions:
How often do you see a doctor, every month or once every year just to get a check-up?
Do you have any existing chronic condition or medication being taken?
What is the maximum you are comfortable spending on premiums and out of pocket?
Infrequent use of doctors gives an upper hand towards a lower premium, higher out of pocket plan as likely to be healthy with minimal expenses. On the contrary, a patient whose medical visits are likely to be frequent or who is ill should choose a costly plan in terms of premiums with lesser co-insurance and reimbursement.
- Compare Premiums, Deductibles, and Out-of-Pocket Costs
Any health insurance is a lot more expensive than the regular monthly premium. You also need to take into account:
Deductible: Out-of-pocket expenses for services before health insurance coverage kicks in.
Co-payments (Co-pays): A preset fee paid for certain procedures, such as visiting doctors and taking medication.
Co-insurance: The share of the bill paid by the insured as an additional payment after the deductible is reached.
Out-of-pocket maximum: This is the amount you can spend on covered services within a year. When this limit is hit, all services provided are at the expense of the insurance company.
Pro Tip: Choose a plan type which is affordable in terms of premiums but at the same time comes with reasonable out of pocket costs considering the health care services that one might need.
- Check the Plan’s Network of Providers
This is very important and requires that you check who your doctors, hospitals and specialists are. When they are out of the network, the medical costs can escalate tremendously. It is common for most insurance providers to have websites and applications that let the users find out if their healthcare provider is part of the insurers network.
Pro Tip: If you have a particular doctor and/or healthcare facility you want to use, make sure to confirm that they are part of the accepted network before you register for the plan.
- Take special note of benefits that are health related
According to the Affordable Health Care Act (AHCA), there are basic benefits that every health insurance provider has to offer to its clients. These include:
Services that make it hard for a person to catch illnesses (Immunisation shots, Cancer tests etc)
Medicines
Pregnancy and infant care
Services for psychiatric and addiction disorders
Admission in a specific facility.
It is also important to ensure that any plan you want to include has these areas of focus, as they may have major consequences on the cost of your health care.
- Medical Options to Extend Coverage
Besides covering accidents and emergency room visits, standard health insurance plans can be complemented with the following additional plans with extra financial coverage:
Extra Insurance for Teeth and Eyes: These programmes are offered for general examination and treatment of the teeth and the eyes. Normal insurances do not normally include these types.
Dread Disease Coverage: It pays out one lump sum in case you are diagnosed with critical illnesses such as cancer or heart attack.
Injury and Emergency Protection Insurance: Helps you when you get injured or meet accidents which are not typically in backup surgery.
If you feel that you may require further coverage, it would be beneficial to look into these options as part of your health insurance.
- Know the Terms of Your Health Insurance Plan
Read the fine print of the plan very well before buying it. Note the following points:
Pre-authorization requirements: There are some health insurance plans which require that the insurance company be contacted and permission to proceed on certain procedures is granted first before the procedure is done.
Exclusions: It is advisable to communicate any aspects of the plan that you find will not be covered beforehand.
Lifetime and annual limits: Most of these days all the plans which are compliant with ACA do not have these limits hence it would be advisable to check what expenses are incorporated within specific diseases or treatments.
- Government Health Insurance Marketplaces
In the event that one needs to purchase an individual or a family plan, the Health Insurance Marketplace (Healthcare.gov) is one of the best places to buy insurance coverage since there are many plans available compared to other insurance firms. The Marketplace enables individuals to view the types of plans that are available in their whole area, check their prices, and ascertain whether they are eligible for some of the reductions offered based on their income.
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