Health insurance open enrollment season gives you an opportunity to select a plan that is right for your health care needs and your budget. These tips will help make comparing and selecting insurance easier.
1. Analyze your needs
In order to ensure that you have enough coverage, review your current medical needs.
Consider:
- What medications you take, how much they cost and how often you fill your prescriptions
- How often you visit your primary care doctor
- What specialists you visit and how often you visit them
- How often you have needed emergency medical care in the last year
- Any medical concerns or symptoms that you have not sought medical treatment for
- How likely it is that you will need to undergo a major medical procedure or be hospitalized in the coming year
- Think about all the above not just for you but also for anyone who will be covered by your plan.
2. Know the terminology
To compare health insurance plans, you’ll need to have an understanding of basic health insurance terminology, including:
- Deductible is the amount of money that you must pay toward covered medical costs before your insurance will cover costs. For example, if your plan has a $1,000 deductible, you will need to spend $1,000 out of pocket before your plan will pay for covered expenses.
- Copayment is an amount of money that you pay for a medical service like a prescription or a doctor’s visit. For example, you could have a plan with a $25 copay for primary care visits and a $50 copay for specialists.
- Coinsurance is an amount of money that you pay toward a medical service. For example, if you had a plan with 20% coinsurance and had a $100 bill from a physician, the insurance would cover $80 and you would pay $20 coinsurance.
- Premium is the amount of money that you pay monthly for health insurance coverage.
- Network is the hospitals, doctors and other medical service providers that have signed a contract to provide care for people with a specific type of health insurance.
- Exclusive Provider Organization (EPO) is a type of plan where your insurance will only cover the costs of medical care from in-network providers unless there is a medical emergency.
- Health Maintenance Organization (HMO) is a type of insurance plan that focuses heavily on integrated care and the prevention of medical conditions. Most HMOs cover patients only from a specific region and require you to use medical providers in their network.
- Point of Service (POS) is a type of insurance where you will pay less when you use in-network medical providers but can also see out-of-network providers. To have care from a specialist covered by the plan, you must obtain a referral from your primary care physician.
- Preferred Provider Organization (PPO) is like a POS plan. This type of insurance allows you to see any medical provider, but you will pay less for in-network providers. There is no need to receive referrals with a PPO plan.
3. Consider your budget
To ensure that the coverage you select is affordable, consider how much you can afford to spend on medical expenses each month. Then, as you compare plans, consider how much each one will cost you in terms of premiums, deductibles, co-insurance and copayments. If you do not visit the doctor frequently, a plan with a high deductible, expensive copays and a low monthly premium may be more cost effective. If you are on many prescription medications and visit doctors many times per year, a plan with higher premiums and low deductibles, co-insurance and copayments is likely to save you money over time.
4. Selecting the right marketplace plan
If you’re purchasing health insurance through an open marketplace, you have four types of plans to choose from:
- Bronze. The bronze plans have the lowest monthly premium and the highest costs for care. Deductibles are usually very high, and you will typically pay about 40 percent of the costs of your care. This type of insurance is best for those who do not visit the doctor frequently but want to be sure they are covered in the case of a serious injury or illness.
- Silver. The silver plans have a higher monthly premium than bronze plans but with lower costs for care. The average person with a silver plan will pay about 30 percent of the costs for medical services and items.
- Gold. The gold plans have a high monthly premium with low costs for care and low deductibles. These plans provide value for the money for people who see the doctor frequently and typically require you to pay for only 20 percent of the costs for medical care.
- Platinum. The platinum plans have the highest monthly costs with the lowest deductibles and the lowest costs for care. With this type of plan, the average person pays for only about 10 percent of the costs for their medical care, making the plans ideal for those who require very frequent medical care.
Sources:
“Understanding key health insurance terms,” Healthcare.gov. U.S. Centers for Medicare & Medicaid Services. 8 Mar. 2018. Web. 5 Jul. 2018. https://www.healthcare.gov/blog/understand-health-insurance-definitions/
“Deductible,” Healthcare.gov. U.S. Centers for Medicare & Medicaid Services. Web. 5 Jul. 2018. https://www.healthcare.gov/glossary/deductible/
“The ‘metal’ categories: Bronze, Silver, Gold & Platinum,” Healthcare.gov. U.S. Centers for Medicare & Medicaid Services. Web. 5 Jul. 2018. https://www.healthcare.gov/choose-a-plan/plans-categories/
“Health insurance plan & network types: HMOs, PPOs, and more,” Healthcare.gov. U.S. Centers for Medicare & Medicaid Services. Web. 5 Jul. 2018. https://www.healthcare.gov/choose-a-plan/plan-types/
Armbrecht, Keith. “6 Tips For Enrolling In Medicare,” Forbes. 16 Oct. 2017. Web. 5 Jul. 2018. https://www.forbes.com/sites/nextavenue/2017/10/16/6-tips-for-enrolling-in-medicare/#394e56fda777
“Getting started with Medicare,” Medicare.gov. U.S. Centers for Medicare & Medicaid Services. Web. 5 Jul. 2018. https://www.medicare.gov/people-like-me/new-to-medicare/getting-started-with-medicare.html
“The Medicare Plans (Yes, Plans),” AARP. 5 Jul. 2018. https://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_the_plans.html
“Medicare Star Ratings,” Medicare Matters. National Council on Aging. 5 Jul. 2018. https://www.mymedicarematters.org/coverage/medicare-star-ratings/?SID=5b3e134899fae148
