How to Choose the Best Health Insurance Plan

Navigating the health insurance market can be daunting, but making an informed decision is crucial for your financial and physical well-being. Here are some key factors to consider when shopping for a health insurance plan, especially if you are self-employed, a business owner, or looking for affordable coverage for your family.

1. Understand Your Health Needs
• Evaluate Your Health Status: Consider any chronic conditions, regular medications, and the frequency of doctor visits.
• Family Needs: If you have a family, assess the health needs of all members. Family plans might be more cost-effective than individual plans. If someone in you or someone in your family has health issues that require frequent doctor visits, labs, and expensive prescription meds this will most likely be the determining factor in choosing a plan.

2. Types of Plans
• Preferred Provider Organization (PPO): More flexibility in choosing healthcare providers, but higher premiums and out-of-pocket costs. This is the most popular plan because it provides you the freedom to go the doctors you need without a referral from a primary doctor.
• Health Maintenance Organization (HMO): Requires you to use a network of doctors and hospitals. Lower premiums but less flexibility. Second most common.  Depending on the size and strength of HMO providers in your area they can be neficial but you will may find limitations if you need care when traveling outside of your area.
• Exclusive Provider Organization (EPO): A mix of HMO and PPO; limited network but no need for referrals.
• Point of Service (POS): Requires a primary care physician and referrals for specialists but offers more provider options than an HMO.

3. Costs
• Premiums: The monthly cost of the plan. Lower premiums often come with higher out-of-pocket costs.
• Deductibles: The amount you pay out-of-pocket before insurance starts covering expenses. Higher deductibles usually mean lower premiums.
• Copayments and Coinsurance: Your share of costs after meeting the deductible. Compare these across plans to understand your potential out-of-pocket expenses.
• Out-of-Pocket Maximum: The maximum amount you’ll pay in a year. Once reached, the insurance covers 100% of costs.

4. Coverage and Benefits
• Essential Health Benefits: Ensure the plan covers services you need, such as emergency services, hospitalization, prescription drugs,  surgeries, and maternity care.
• Additional Benefits: Look for extras like telehealth, dental, vision, mental health services, and wellness programs.

5. Provider Network
• In-Network vs. Out-of-Network: Check if your preferred doctors and hospitals are in the plan’s network. Going out-of-network can significantly increase costs. There are many out-of-network providers that will accept your insurance but this can be a surprise when you get the bill. When you go out of network you don’t benefit from the negotiated in-network discounts.
• Access to Specialists: Ensure the plan provides access to specialists you might need.

6. Prescription Drug Coverage
• Formulary: The list of covered drugs. Make sure your medications are included and check the cost tiers and maximum coverage limits.
• Pharmacy Network: Confirm if you can use your preferred pharmacy.

7. Customer Service and Support
• Ease of Access: Consider the availability of customer service for questions and claims support.
• Digital Tools: Look for user-friendly websites and mobile apps for managing your plan and accessing care.

8. Travel Considerations
• Domestic Travel: Ensure your plan provides coverage when you are out of your home state. Some plans may have limited networks and higher costs when you receive care out-of-state. Most ACA Obamacare plans provide limited coverage when you leave your resident state or area.
• International Travel: Check if your plan includes international coverage or if you need to purchase additional travel health insurance. Coverage for emergencies, evacuations, and routine care while abroad are essential.
• Emergency Services: Verify that emergency services are covered no matter where you are, as emergencies can happen anytime and anywhere.

9. Regulatory Considerations
• State vs. Federal Marketplaces: Depending on where you live, you might shop for insurance through a state marketplace or the federal Health Insurance Marketplace.
• Subsidies and Tax Credits: Check if you qualify for financial assistance based on your income, which can reduce premiums and out-of-pocket costs.

Choosing the right health insurance plan requires careful consideration of your health needs, financial situation, preferences for healthcare providers and services, and travel habits. By evaluating these factors, you can find a plan that provides the coverage you need while managing costs effectively.

Remember: Health insurance is not one-size-fits-all. Take the time to compare options and make an informed decision to safeguard your health and financial future, especially when you’re on the move. Here are some key questions to ask yourself that will help guide you in determining the right plan for yourself and your family.

• Are you relatively healthy and active or do you have some health issues that require expensive medications and specialist?
• What type of doctors do you go to?
• How often do you go to the doctor?
• Do you like your doctors and want to keep them?
• Do you like the freedom to go to the doctors you choose?
• What prescriptions are you on and will the plan cover it?
• Do you travel and want to have coverage when you leave your home state?

If you would like more information on plans for your specific needs schedule a call with us by clicking the contact us or schedule an appointment button here on the website.

Mike Brenhaug
Licensed Independent Insurance Broker
Specializing in Healthcare and Retirement Services

SmartSolutionHealth.com