When it comes to health insurance, it can be very overwhelming to make a decision, especially with all the options out there. You may decide to purchase a plan independently, through healthcare.gov, or you may opt for the health insurance coverage offered by your employer. Even then, it can seem like there is an endless amount of plans to choose from. Lower monthly premiums will usually mean higher deductibles, and vice versa—so how can you decide what to do?
There are a lot of different factors to take into consideration, such as your monthly expenses, current health, medical history, age, and so on. Another thing to consider is whether you’re just looking for coverage in case of something serious, or if you’d like a plan that also covers minor conditions as well. Even after you think about these things and narrow down your needs a bit more, it can be hard to decide. The following tips can help you find the healthcare coverage that meets your needs and your budget:
Don’t just jump on the first healthcare plan you find that offers good benefits with an affordable premium. Before you make any final decisions, shop around first and compare several different plans. Contact some health insurers directly and ask questions about specific medical conditions, costs, etc. You may discover that the plan you initially wanted to sign up for may not be the best one for you after all, and you might find one that’s a better match for you.
Understand your share of the costs
Every type of health insurance policy has different billing procedures set in place; you might pay flat fees out-of-pocket whenever you go to the doctor (copayments), or you might be billed later on for a portion of the services. Find out how the payment structure works ahead of time for any plan you’re considering, so that there aren’t any unpleasant surprises.
Identify the necessities
Nobody can ever predict an accident or sudden illness, but you may be able to identify other medical needs that you’ll want to have covered before you finalize your health insurance choices. For example, if you’re trying to pregnant, you’ll want to find a policy that includes maternity coverage, and eliminate the ones that don’t.
Factor in your dependents
If you’re married and/or have children, you’ll want to consider looking into a plan that you can all be on. With a group policy, it can be cheaper to add on dependents, rather than have separate health insurance policies for everyone. However, be sure to compare the different costs first—in some cases, it can be cheaper to leave things as they are, and just purchase an independent policy for yourself.
Make sure you’ll be receiving coverage for your prescriptions
If you take any medications on a daily basis, you’ll want to make sure you choose a health insurance policy that partially or completely covers the cost. Some medications can be very expensive, and since they’re often a necessity, this is an important detail you won’t want to overlook.
PPO vs. HMO
Another big decision to consider is whether you want an HMO or PPO plan. There are a lot of differences between the two, but generally speaking, a PPO plan tends to offer more flexibility—yet also tends to be the costlier option. With an HMO, you’ll usually need to designate a PCP (primary care physician) and receive a referral from your doctor anytime you need to see a specialist. With a PPO, you can usually see any specialist within your network, and without getting a referral first. If the flexibility isn’t important to you and cost is a primary concern, you may be better off with an HMO. Otherwise, a PPO may be your best bet.
Stay in the network
If you’ve just moved somewhere new or you’re in between doctors and haven’t decided on one yet, this won’t make a difference. However, if you are already receiving care from a doctor or specialist that you’re happy with and you don’t want to have change doctors, be sure that any health insurance plan you’re considering will include them in the plan’s network. By going out-of-network, you’ll often have to pay out-of-pocket (or at least more if you were to stay in-network), so unless you don’t mind switching doctors, stay within the network when making your healthcare coverage selection.
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Nothing above is meant to provide financial, tax, or legal advice. You should meet with appropriate professionals for such services.