Reviewing the aspects of your benefit and coverage options can help you choose the plan that best meets your health needs.
Choosing the right health plan can feel like navigating a maze, but it’s a crucial step that can significantly impact your well-being and financial health.
Understanding the basics of health insurance plans
First, familiarize yourself with key insurance terms.
- The premium is the amount you pay each month to maintain coverage.
- The deductible is the amount you must pay out of pocket for care before your insurance begins to share your health care costs.
- Copays are fixed amounts you pay for specific services, such as seeing a doctor or filling a prescription.
- Coinsurance is the percentage of costs you pay after you meet your deductible.
- The out-of-pocket maximum is the most you will pay for covered medical expenses in a year, including deductibles, copays, and coinsurance. If you reach this limit, your health plan will cover 100% of your remaining eligible medical expenses for the rest of the year.
Learn about the types of health insurance plans available
Knowing what is important to your family can help you choose a plan that meets your needs.
- Health maintenance organizations (HMOs), which often offer lower costs, may require you to choose a primary care physician (PCP), get referrals for specialist visits, and use a defined network of providers.
- Preferred provider organizations (PPOs) provide greater flexibility in choosing doctors and hospitals, both in and out of network, but have higher premiums and higher out-of-pocket costs.
- Exclusive provider organizations (EPOs) don’t require referrals for in-network specialist care, but they do not cover any out-of-network services.
- Point-of-service (POS) plans allow you to use in- and out-of-network providers, but they require referrals for out-of-network visits and can be more expensive.
Evaluate network and provider options
Before selecting a health plan, determine if the doctors, hospitals, and specialists you prefer are included in the network. Many health plans provide online tools to search for specific providers, or you can contact the insurance company directly.
If you are looking for new or additional providers, make sure the network has good coverage in your location. You also can research the quality and reputation of network providers you may be considering. Online resources provide detailed profiles of doctors and hospitals, including patient satisfaction scores and professional qualifications.
Consider prescription drug coverage
Prescription drug coverage can have a significant impact on your health care expenses. Health plans typically base coverage on a formulary, which is a list of covered medications. Review the formulary and check whether the medications your family needs now or may need in the future are included. If a medication you rely on isn’t covered or has a high copay, you might want to look for a plan that better aligns with your needs.
Convenience and cost savings are also factors. Many health plans offer home delivery options that can provide a 90-day supply of medications, often at a savings.
Explore additional benefits and services
Plans may offer additional benefits and services that can enhance your health, such as access to wellness programs with resources such as fitness tracking apps, nutrition counseling, and smoking cessation programs.
Some plans offer vision and dental care as part of their comprehensive coverage, while others require separate policies or supplemental insurance.
By carefully evaluating these variables and benefits, you can choose a health plan that best meets your health care needs while supporting your overall well-being and financial health.
How to choose the right plan
The right coverage depends on your individual needs.
