Shopping for health insurance – it’s right there at the top of the list of things we all dread doing, along with jury duty, doing our taxes, and going to the dentist. With so many options out there, it’s no wonder most people just stick with whichever plan they get through their employers or simply opt-out of health insurance altogether. If you’re currently in the market for a private health insurance plan, take a deep breath.
Check out these 5 things you should consider when shopping around.
When it comes to choosing between an HMO and a PPO, it’s helpful to consider your current medical situation and your lifestyle. If you’re generally healthy and make minimal visits to the doctor each year, maybe an HMO is for you. HMOs typically have a limited number of in-network providers, and many times a visit to a specialist requires a visit with and a referral from your primary care provider. In contrast, a PPO plan may offer more flexibility and fewer restrictions. A greater variety of providers are available with a PPO plan, and oftentimes you don’t need a referral from your primary care provider to visit a specialist. If you currently see a specialist and you don’t want the hassle of getting a referral from your primary care provider, a PPO plan might be the right fit for you. Also, if you travel frequently, you may have an easier time receiving out-of-town care with a PPO plan.
When shopping for a health insurance plan (or anything, really), the first question we usually ask ourselves is, “How much is this going to cost me?” There are a few different costs you must consider when choosing your healthcare plan, the most immediate being the insurance premium. Your insurance premium is the amount you pay for coverage, and you pay the premium whether you end up using your insurance or not. It should be factored in with your other monthly expenses if you’re on a budget.
Co-pays and Deductibles
Co-pays are the out-of-pocket payments you are responsible for paying when receiving any covered services (for example, seeing your doctor or getting an MRI) and for prescriptions. You can usually find those fees on your insurance card. If you’re unsure, you can call the insurance company directly. A deductible is an amount you must pay out of pocket before your insurance coverage begins. A plan with a higher deductible typically boasts a lower monthly premium, while a lower deductible will come with a higher premium. If you are pretty healthy, see your doctor once per year, and rarely need emergency services, a low premium/high deductible plan may work for you. However, if you have a complicated medical history, it might be worth taking a second look at that higher premium/low deductible plan.
If you are currently taking prescriptions, you’re going to want to peruse your insurance company’s formulary or list of medicines that your plan covers. The formulary will have the covered medications separated into tiers. These tiers will indicate what the co-pay would be for your prescription medication.
Now that we’ve discussed the costs and expenses of insurance coverage, let’s talk about the perks. Yes, perks! Many plans offer their members incentives and wellness programs to stay healthy, such as free gym memberships and 24-hour health helplines.
Shopping for a private health insurance plan can be daunting, but it doesn’t have to be a headache! Take your time to research and ask questions. Most importantly, if you need help, ask for it.