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How To Compare Coverage When Shopping For Health Insurance?

Being you only have a limited time to pick a health insurance plan for you or your family, knowing what to pick in advance could prevent you picking the wrong one (which could be expensive). Whether you are getting insurance through an employer or a state or federal marketplace…here are some things to keep in mind when comparing coverage.

Knowing Your Needs

Knowing your medical history is important when choosing the best insurance for you. If there are specialty doctors you will need to see or multiple medications you will need to take a month, all of this could play into your decision. Having a good idea of your medical history and even your family’s medical history, can help you prepare and prevent out of pocket expenses.

Compare Health Insurance Plans

Talk to your agent about the following plans to see which would work best for you. 

  • HMO (Health Maintenance Organization): Lower out-of-pocket costs and a primary doctor who coordinates your care for you. Referrals required to see a specialist and you must stay in-network (except for emergencies). 
  • EPO (Exclusive Provider Organization): No referrals required and lower out-of-pocket costs but less freedom to choose providers. Must stay in-network (except for emergencies). 
  • PPO (Preferred Provider Organization): More provider options and no required referrals; higher out-of-pocket costs. You are able to go out of the network but it will be more expensive. 
  • POS (Point of Service Plan): More provider options and a primary doctor who coordinates your care for you. To see a specialist you will need a referral and you are able to go out-of-network but it will be more expensive. 

You will want to see a summary of benefits (which will explain all of the plan’s costs and coverages). You will also want to weigh your family’s medical needs to see what plan would work best for all of you. If you think you will need a specialist, you will need to further investigate the referral system. If you want to pick your own specialists, a PPO or EPO may be a better option for you. If you are more focused on cost, HMO would be a better bet. 

Out of Pocket Costs

When choosing your plan you need to be aware of the different out of pocket costs you will encounter when receiving medical care. Knowing what each of these costs mean and how much they will be may help you pick the proper insurance for yourself and family.

  • Premium: The monthly amount you will pay for your health insurance plan.
  • Deductible: The amount you pay for covered medical care before your insurance plan/company starts paying.
  • Copay: A flat fee that you will pay each time you receive a health care procedure or service.
  • Coinsurance: The percentage of the medical charge you will have to pay. The rest will be covered by your health insurance plan.
  • Out-of-pocket costs: All of the costs above a plan’s premium that you are responsible for paying (copays, deductibles and coinsurance).
  • Out-of-pocket maximum: The most money you’ll pay in one year (from your own pocket) for health care. Once you hit this number, your insurance pays the rest.

If you are in good health and rarely see a doctor, a lower premium with higher out-of-pocket costs may be better suited for you. If you see a primary care physician or specialist frequently, take expensive medications, have a planned surgery, are expecting a baby or have small children, frequently need emergency care or have been diagnosed with a chronic condition, paying a higher monthly premium that has more coverage and fewer out-of-pocket expenses will be best for you.

If you have any questions about what coverage you currently have and what you might want to change for next year’s enrollment period, call Health Benefit Services today and speak to one of our agents!

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