Health insurance can be confusing. There are so many different plans, with so many different benefits and exclusions, and co-pays. And when you’re trying to figure out which plan will best suit your needs, it’s hard to know what questions to ask or where to get the answers. But don’t worry! In this post, we will discuss how to the best insurance plan for you and for your family.
We’ve put together this guide on how to choose the best insurance plan for your needs—and budget—so that you can make an informed decision about whether your current coverage is working for you or if it’s time for a change.
Start with your insurance company
It’s always a good idea to start with your insurance company. They have the best understanding of your needs and of the marketplace, so they can help you find a plan that fits your budget.
They’ll provide estimates of how much it will cost to get certain coverage levels, and they’ll also be able to tell you what other plans are available in your area.
If an agent doesn’t give you any options or suggestions, ask them to help you choose the right one for you!
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Consider HMO, PPO, and EPO
Health Maintenance Organization (HMO): The HMO is one of the most restrictive types of insurance plans. It contracts with specific doctors and hospitals to provide services, which you can use only at those participating providers. If you go to a provider that isn’t in your network or try to get an out-of-network service such as emergency care outside of your area, your insurance will not cover it.
PPO: A Preferred Provider Organization (PPO) is similar to an HMO except that it allows patients more flexibility in choosing their providers as long as they still use approved ones within their network. You’ll have greater freedom than someone with an HMO plan, but less than someone on another type of health insurance plan where there are no restrictions on where you go or who performs the procedure(s).
EPO: An Exclusive Provider Organization (EPO) has networks similar to those found in PPOs but also requires enrollees to choose from a list of preferred physicians and institutions when scheduling medical procedures rather than allowing them access through any participating provider in the network.
Look at what you use and what you need
When choosing an insurance plan, it’s important to look at what you use and need. For example, if you are on prescription drugs, then a plan with a low deductible or out-of-pocket maximum will be helpful.
Look into the coverage offered by your employer as well as other options that may be available through the marketplace or exchange in your state (also called exchanges). You can compare different plans side by side using HealthCare.gov’s calculator tool.
If you have a pre-existing condition, find out whether your new plan offers protection from being denied coverage or charged more for insurance because of this condition. This is called guaranteed issue and community rating protection in all states except Vermont and New Hampshire.
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Some states also require insurers to offer maternity care for otherwise non-pregnant women who would like to purchase maternity riders on their health insurance policies; others don’t allow riders at all (these are called “essential health benefits”).
Calculate your costs
To choose the right insurance plan, you need to calculate your costs. This means finding out how much it will cost for each type of coverage and comparing different plans that offer different amounts of coverage. For example, if you want to insure your home and its contents against fire damage, consider two different options:
- A $100,000 policy that covers only the structure (the bricks and mortar) of your house but leaves out any personal items like computer equipment or clothing
- A $250,000 policy that covers both structures as well as all possessions in your home
Check to see if your plan covers pre-existing conditions
A pre-existing condition clause is a stipulation that says that the insurance company will not cover medical bills for any illness or injury you may have had before signing up for your new plan. These clauses are common in many health insurance plans, but there are some exceptions:
- Some states don’t allow them (although this varies from state to state)
- Some plans do not include pre-existing conditions at all
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Compare out-of-pocket expenses to premiums
When you’re comparing health insurance plans, it is important to consider the amount you will have to pay for care every year. Out-of-pocket expenses are the amount you pay for care before your insurance plan starts paying. These costs can include co-pays and deductibles, which may be different from the premium (monthly cost).
You can compare out-of-pocket expenses to premiums by looking at each plan’s official overview or summary of benefits and coverage (SBC), available on its website or in a brochure mailed to you when applying for coverage. You can also use this information to compare with other health plans offered by your employer or state exchange.
If one health plan has higher premiums but lower out-of-pocket expenses compared with another option, this could be a good choice if it fits within your budget and meets the other criteria we discussed earlier in this guide:
Consider a high-deductible health plan
A high-deductible health plan can be a good choice for you if:
- You don’t go to the doctor regularly and are willing to pay more out of pocket when you do go.
- You’re healthy, but want some protection against major medical expenses. If you have a chronic illness or disability, it’s important to consider a high-deductible plan carefully because they typically don’t cover routine care such as checkups and immunizations.
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You can still find health insurance that gives you the coverage you want for the cost you can afford
You can still find health insurance that gives you the coverage you want for the cost you can afford. It is important to do your research before deciding on a plan and make sure it meets your needs. You should consider how much you can afford to pay each month and how much of an emergency fund you have in case something happens with your health or your family’s health.
The truth is that there are plenty of options when it comes to choosing health insurance. You just have to know where and how to look for them. And if you need help with that, we’re here for ya! Just give us a call at 1-800-942-3687 and we’ll be happy to answer any questions or concerns you may have about choosing the right plan.
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