The health insurance industry has become a hot topic in today’s time. Somewhere between news and political debates, it seems as though no one is wholly satisfied with their policy. With so much confusion in the air, it’s about time that people were informed on how to go about picking the right coverage.
There are hundreds of companies offering health insurance for individuals, which can make finding the right one for your needs challenging. Consider this your step by step guide to choosing the best insurer possible.
The Right Marketplace
This first step is divided between those with employee health plans and those without. If your place of employment offers all of the coverage you need, that’s great! However, many find that their employee health plans only cover the bare minimum.
If you choose to seek out an alternative insurance plan, most employers are required to pay a portion of your premium so long as they already offer employee health care. Those whose employers do not provide coverage can head straight to their state’s marketplace, or the federal marketplace if their state does not have one. Alternatively, anyone can choose to purchase health insurance through a private exchange or directly from an insurer.
Finding the right marketplace is just a matter of whether your employer offers benefits or not, and if those benefits provide the coverage you need. .
This is where many get confused by a sea of letters like HMO and EPO. Here’s the breakdown:
- HMO: A primary doctor that coordinates your care for you, such as tests. These plans require referrals that your doctor will handle, and you can only go outside of the network in emergencies.
- PPO: This allows you to choose from a list of doctors and providers with no referrals necessary. You can receive coverage out of your network, but it is more expensive.
- EPO: This option offers low costs if you can find a provider in the network and requires no referrals. You must stay within the network, except for emergencies.
- POS: A primary doctor will coordinate your care, like in an HMO, but you also have provider options. You do not have to stay in network to receive coverage, though it is cheaper and you will need a referral to head out of the network.
You will want to look at any plan’s summary of benefits, which can be found with the cost next to the title. Next, you will need to look for the directory to find which doctors and clinics participate in the plan’s network.
This final step involves looking at health plan networks, out of pocket costs, and benefits. Comparing networks is as simple as choosing one with plenty of doctors and specialists in your area. This helps save on costs associated with heading out of network, and can allow you to see your preferred doctor depending on the plan you choose.
Comparing out of pocket costs includes looking at the deductible, copayments, and coinsurance to determine how much you would have to spend. In general, lower premiums incur higher costs. A higher premium might be better if you need frequent care.
Benefits vary widely, with some plans providing better coverage for things like physical therapy and others offering better emergency coverage. Choose the benefits that best suit your needs. Perhaps you will rely on your insurance for covering medication costs, or maybe you will need maternity services down the road.
Choosing the right insurance doesn’t have to be as complicated as companies make it out to be. Just follow these simple steps and you’ll have the coverage you need at a price you can afford.