Choosing The Best Health Insurance Plan: How To Go About It
It’s time for you to get your own health insurance. Your employer doesn’t offer health insurance, and you know that if you don’t get it in time, you can be charged a fine.
But honestly, you’re dreading it. The Health Insurance Marketplace — where you go to determine your eligibility for health insurance and to select a plan — can seem overwhelming. So, you’re not looking forward to sifting through all the information out there.
Knowing what to look for is half the battle, but where do you even start?
Here’s how to go about choosing the best health insurance plan from the Health Insurance Marketplace that fits your needs.
What Plans Should Cover
All plans on the Marketplace must have essential health benefits (EHB), free preventive services, and cover pre-existing conditions, says the US Centers for Medicare & Medicaid Services.
Essential health benefits, according to the US Centers for Medicare & Medicaid Services, include:
- Any outpatient care needed
- Hospitalization for surgery and overnight stays
- Pregnancy, maternity, and both before and after newborn care
- Counseling and psychotherapy for mental health and substance use disorder services
- Prescription drugs
- Rehabilitation and habilitation services and devices
- Lab services
- Wellness and preventive services, along with chronic disease management
- Pediatric services
Consider Your Monthly Premiums
A premium is the amount you have to pay every month for insurance whether you use it that month or not, says the US Centers for Medicare & Medicaid Services. So, make sure you pick one that fits into your budget — and your healthcare needs.
Just because a premium is on the low end doesn’t mean that it’s automatically better for you. You have to consider the whole picture, especially how much it will cost you when it’s time to receive care.
If you opt to get a plan with a lower monthly premium, be aware that when you need care, your out-of-pocket costs may, in fact, be higher. And if you have a higher monthly premium, then your out-of-pocket costs will more likely be lower.
Tally Potential Out-Of-Pocket Costs
Out-of-pocket costs can add up quickly. In addition to what you’ll pay for services your insurance may not cover, don’t forget about other charges like copays.
Luckily, all Marketplace plans have an out-of-pocket costs cap on them, according to the US Centers for Medicare & Medicaid Services.
When you’ve reached these amounts through deductibles, copays, and co-insurance, the insurance then pays 100% of your covered care expenses.
Evaluate Plan Type And Provider Network
Different plans have different amounts of coverage depending on where you seek service — whether it’s inside or outside your plan’s network, says the US Centers for Medicare & Medicaid Services.
Here are 4 types of plans the Marketplace offers, according to the US Centers for Medicare & Medicaid Services:
- Exclusive Provider Organization (EPO): Services received are covered only by in-network providers, such as doctors, specialists, or hospitals. The only exception: emergencies.
- Health Maintenance Organization (HMO): Only care given by doctors who contract with or work for the HMO is covered unless it’s an emergency. You must either live or work in the HMO service area to have coverage.
- Point of Service (POS): You pay less for using doctors, hospitals, and other providers in the plan’s network. You have to get a referral from your primary doctor before you can see a specialist.
- Preferred Provider Organization (PPO): You pay less when you use in-network providers. You must get a primary care physician to refer you to a specialist. You can use non-network providers without a referral, but it will cost you more.
Before you apply, be sure to compare any plans you’re considering. Each plan in the Marketplace will have a benefits summary, plan brochure, provider directory, and a list of covered prescriptions, according to the US Centers for Medicare & Medicaid Services.
