No one wants to get sick or hurt, but common illnesses like colds and stomach bugs are inevitable, and rare is the individual who goes a lifetime without a notable injury. Furthermore, most people desire medical care that involves routine examinations and health screenings. Health plans help to defray the costs of such care.
HealthCare.gov says health insurance provides free preventive care, such as vaccines and some wellness visits, even before having to meet a deductible. Without health insurance, individuals may delay much-needed medical care because of the cost until conditions become intolerable. At that point, extensive intervention may be needed or treatment may no longer be possible.
Depending on a person’s age or where that person lives, health care may be provided by the government. But many individuals have to secure their own health insurance or enroll in plans through their employer. The following tips can help people choose health plans that work for their needs.
Premium costs
The premium is the amount of money that comes out of the policyholder’s pocket each month or pay period. When health insurance is offered through an employer, a portion of that cost is paid by the employer with the balance being covered by the employee. The premium will differ depending on whether a single individual will be insured or if coverage will be extended to a spouse and/or children.
Individuals with no employer-sponsored health plan can shop their state’s online marketplace for U.S. residents if available or the federal marketplace to find a plan; otherwise, one also can purchase a health plan directly from an insurer, but that is likely to be the most expensive route.
Alphabet soup
Health plans are all about the acronyms. There are HMOs, PPOs, EPOs, and POS plans. Each of these offerings is unique in regard to coverage and requirements. Generally speaking, an HMO is the least expensive initially but may be the most restrictive in choosing providers. A PPO has more provider options but higher out-of-pocket costs. EPO and POS plans fall in between. Therefore, shoppers need to determine their priorities before choosing plans, such as whether they can stay in-network.
Deductibles, co-payments and coinsurance
Additional considerations when comparing health plans include deductibles, co-payments and co-insurance costs. Nearly all plans will feature some sort of combination of these costs, which are in addition to the deductible. For example, there may be a $20 co-payment required for standard visits and a higher amount for specialists. Deductibles are the amount of money that has to be spent before the plan starts paying for specific health care costs, like lab work or imaging. Coinsurance is a percentage owed on certain procedures. For example, a patient may be responsible for 20 percent of surgery costs and the other 80 percent is covered by the plan. Plans typically will list the maximum out-of-pocket expense for the calendar year.
Shoppers also should consider if the providers within each plan operate near their homes. Coverage for prescription medications is another point to consider.
Shopping health plans can be confusing. Learning the lingo and doing your homework is necessary to ensure you find the best plan.
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