Figuring out the Right Health Insurance Plan for your Lifestyle.
It’s Open Enrollment Season for 2024 Health Insurance Plans with the opportunity to sign up for next year’s plans starting Oct 15, 2023. It’s important to use this time to review your options, think through your healthcare needs and confirm or potentially change health insurance plans.
With medical costs being so high, selecting the right health insurance plan can be a critical decision for your financial and medical well-being. Below the Tricky Bills team has included some key factors to consider when selecting a health insurance plan:
Understanding your healthcare needs will help you select the right coverage for your lifestyle and conditions.
Coverage:
Consider the range of medical services covered, such as doctor visits, hospital stays, surgeries, preventive care, and prescription drugs.
Check if the plan covers specific medical conditions or treatments you may need, especially if you have existing health issues.
Remember that insurance plans cannot deny you for pre-existing conditions, but having a condition could raise the rate of the plan you look at. Cost matters as well as coverage.
Network:
Determine if your preferred healthcare providers (doctors, hospitals, specialists) are in-network. Going out-of-network often results in higher out of pocket costs.
Once you have narrowed down the plans you are interested in, call your doctor’s office to make sure that they are in fact participating. *Often the insurance companies’ list of participating physician is incorrect.
For an HMO Plan, make sure you understand the process to see specialists. And, how easy it is to secure a referral for specialists, if needed.
Premiums:
Premiums are the monthly fees you pay to have the insurance plan. Consider your budget and select a premium level that is affordable for you and your family.
If you work for an employer that pays for all or part of your premium. Understand what % of your monthly premium is covered by your employer for each plan and what you will owe on a monthly basis.
Deductible:
The deductible is the amount you must pay out of pocket before your insurance starts covering expenses. Plans with lower deductibles often have higher premiums and vice versa.
When looking at premiums and deductibles also consider reviewing HSAs and/or FSAs, as these savings accounts can help pay the healthcare spending required to meet the deductibles.
Co-pays and Co-insurance:
Understand how much you'll need to pay for each doctor's visit, prescription, or hospital stay. These can vary between plans. A co-pay is a required payment and in some cases a physician practice will require payment for your visit before you see the doctor.
Co-insurance is the percentage of costs or detailed amount you'll need to cover after meeting your deductible. Co-insurance is an “every time” payment you are required to make when you go to a provider, whether hospital or doctor’s office.
Maximum Out-of-Pocket Costs:
Check the plan's maximum limit on what you'll have to pay in a year for covered services. Once you reach this limit, the plan covers 100% of eligible expenses.
Prescription Drug Coverage:
If you take regular medications, ensure they are covered by the plan and that the costs are reasonable.
Drugs are usually listed in a tier methodology whereby some drugs are zero co-pay while others may be $100 copay for more expensive drugs or brand name varieties. Some drugs may not be covered by your insurance, talk to your pharmacist about your prescriptions and coverage, they can look it up for you to help with your decision making.
Additional Benefits:
Some plans offer extra perks like dental, vision, mental health, or wellness programs. Consider if these are important to you.
Provider Access:
Consider whether you prefer HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plans. HMOs usually require referrals and have a limited network, while PPOs offer more flexibility but may cost more.
Health Savings Account (HSA) or Flexible Spending Account (FSA):
If you're eligible, these accounts can help you save money on healthcare expenses by allowing pre-tax contributions.
Another benefit is to ask about employer contributions to your HSA. Many employers will pay a flat contribution amount or contribute matching funds. Talk to your HR department.
Read More about HSAs in our article HERE.
Coverage for Family Members:
If you have a family, ensure that the plan meets their needs, including coverage for spouses and dependents.
If both spouses are covered by their employer for healthcare, compare pricing and coverage between the two plans. Depending on coverage it may be possible that you decide not to add a spouse to your plan. Child coverage should go to the plan with the best well care coverage and best price.
Coverage While Traveling:
If you frequently travel or live in multiple locations, consider whether the health insurance plan offers coverage outside your primary location.
If you do international travel, check to see if there is coverage for emergency and or urgent care. You may have to pay out of pocket and then bill your insurance for repayment afterwards.
Reviews and Ratings:
Research the insurance company's reputation, customer service, and customer reviews to get a sense of their reliability.
You can also check with the Attorney General’s office for your state as well as the Insurance Commissioner’s office for complaints.
ACA Compliance:
Ensure that the plan complies with the Affordable Care Act (ACA) regulations, including essential health benefits and preventive care.
The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive healthcare reform law enacted in the United States on March 23, 2010. It represents a significant overhaul of the U.S. healthcare system with the goal of expanding access to affordable healthcare and improving the quality of care for millions of Americans. (see post for ACA as defined by government)
Changes in Life Situation:
Anticipate any significant life changes (e.g., marriage, having children, retirement) and how they might impact your insurance needs.
Each person's health insurance needs are unique, it's essential to carefully review plan details, compare options, and consider your personal circumstances and preferences when deciding. You may also want to consult with an insurance broker or a trusted financial advisor to help you navigate the options available in your area.
