As you might imagine, choosing the right health insurance plan can be quite difficult. From finding an affordable option that meets your needs to determining which health services you want to cover, there’s no shortage of details to consider. Fortunately, with the right approach and information, you can make the best possible decision for your health and budget without getting overwhelmed or confused. In this guide, we’ll walk through how to choose the right health insurance plan based on your individual situation, so you have peace of mind knowing that you’re getting exactly what you need from your coverage at all times.
Should you get individual or group health insurance?
The type of plan you get will depend on a number of factors, including how many people are in your family, where they live and how much money you make. In general, if there’s one parent working full-time and another stay-at-home parent (or one working part-time), group health insurance is likely going to be more cost effective. However, if you have two working parents who both work full-time or even two working parents who both work part-time, individual health insurance might be a better option because it allows you to tailor your coverage based on what each person needs. It also gives you flexibility to change jobs without changing plans because individual plans are tied directly to individuals rather than employers.
Let’s start with your income
Before you can buy health insurance, you need to know your annual income. This is needed to determine what types of tax credits or subsidies might be available if you apply for coverage through one of the state or federal marketplaces. If your income changes over time, be sure that you report it annually so that your subsidy stays accurate. Otherwise, you could end up paying more than necessary each month.
What about employer-provided plans?
Employer-provided health insurance is a great perk, but it’s not right for everyone. If you are already enrolled in an employer-provided plan, it might be a good idea to take advantage of your employee benefits by asking your human resources department if they offer a cost-sharing reduction (also called CSR or HRP). The Affordable Care Act offers lower deductibles and premiums for people who meet certain income requirements.
Medical underwriting - how does it work?
Medical underwriting is an optional process you can use when you’re buying individual health insurance. It allows you to give your current or recent medical history to an insurance company, which then uses that information (and other information like family health history) as part of its determination on whether it will sell you a policy or what sort of premium it will charge.
Do I need an in-network provider?
If you choose a traditional health plan, you will need in-network coverage. In-network providers are preselected by your insurer. The insurer negotiates a discounted fee with these providers, but that doesn’t mean they won’t charge more than an out-of-network provider. If you choose a PPO or EPO, you can pick any in-network doctor. However, if you visit a specialist who is not in your network, it may be difficult to find an in-network physician who accepts your insurance. And if you do find one, he or she may not accept your insurance’s payment rate as full payment. That means you could owe additional money at time of service—or even after services have been rendered.
Can I be denied coverage?
Under federal law, insurers are not permitted to deny coverage to people with pre-existing conditions. However, insurance companies can refuse to cover a condition after it’s been diagnosed. That means someone who is newly diagnosed with diabetes may be able to obtain health coverage, but he or she could be denied treatment of that disease by an insurance provider.
What are my out-of-pocket costs, anyway?
When choosing your health care insurance plan, it’s important to take a look at what are called out-of-pocket costs (OPC). OPC includes copayments, deductibles, coinsurance, and noncovered services. While these costs can vary from plan to plan, they usually represent a pretty big chunk of overall expenses. The bottom line? Take a close look at what you’ll be paying before deciding on an insurance company.
Will I save money with a high deductible plan?
High-deductible health plans have lower monthly premiums but higher out-of-pocket costs, so they’re only a good choice if you’re disciplined enough to pay more money when you need healthcare services. That’s a pretty big if. Let’s look at why high deductible plans might not be worth it.
What are HSA accounts and how do I use them?
Insurance companies offer high-deductible health plans, or HDHPs (plans with higher deductibles and lower premiums), people are looking for low-cost ways to pay for their deductible. An HSA (health savings account) is a type of savings account that allows you to save money tax free for medical expenses. It’s different from an FSA (flexible spending account) in that you own it and can use it whenever you want. The funds roll over year after year, so if you don’t spend them all one year, they stay there for future use. This is one reason HSAs are popular among millennials who tend to be healthy but have concerns about long-term care needs as they age. In addition to using your HSA funds on everyday health care costs like copays and prescriptions, you can also use them on things like dental work and vision care.