Your employer might offer health insurance, or you might be shopping independently for coverage; finding the appropriate healthcare plan can meet all of your medical needs at an affordable cost. When comparing plans, look for networks that include your preferred doctors and medications. By choosing in-network providers, you can lower your costs by receiving reimbursement at more favorable negotiated rates. Compare monthly premiums, co-pays, and deductibles across plans until you find one that best meets your budget needs.
1. Cost
Healthcare coverage protects you against expensive medical bills but comes at a price. Premiums, deductibles, copays, and coinsurance all add up to form the total cost of coverage. Examine how much you can afford monthly for a plan and compare costs before considering which type of care is most suitable to your needs, whether that means using your doctor or specialist.
Check your current provider’s member portal or online directory to determine which doctors and hospitals are part of its network. Most plans offer a list of in-network providers, while others give more freedom and allow for out-of-network visits at additional costs.
2. Network
When shopping for health plans, keep the following in mind when making decisions: when selecting physicians you plan on seeing, make sure they are in-network; compile a list of prescription you and your family take and confirm if they fall under each plan you consider.
Some plans offer different networks; an HMO only covers care from physicians within its network and requires you to choose a PCP who will refer specialists as needed. A PPO usually allows more flexibility with regard to care outside its network, although you’ll pay more.
3. Benefits
Prior to choosing your health insurance plan, it’s essential to carefully consider your desired needs. For example, if you do not anticipate using many healthcare services, an option with lower premium payments and a high deductible might be more suitable for you.
Individual health insurance plans on the Health Insurance Marketplace are organized into “metal” categories, each offering distinct benefits to employees. Selecting an appropriate plan can have lasting implications on an employee’s finances and peace of mind for years. Here’s how you can compare health plans so that you can find one best suited to your needs:
4. Exclusions
Understanding what’s excluded from a health insurance plan is as vital as understanding what’s included. Doing so will prevent disappointment when filing claims later on.
Be sure to read each policy document closely to fully comprehend any exclusions associated with each plan, especially pre-existing conditions that aren’t covered without full medical underwriting or an agreement for a moratorium period. Waiting periods are an integral component of health insurance plans, as your insurer must assess the costs involved with treatments before covering them.
5. Pre-existing Conditions
Recent headlines regarding pre-existing conditions have provided much confusion as to their meaning for health insurance policies. Under the Affordable Care Act (ACA), pre-existing medical conditions cannot lead to denial or increased premiums under coverage plans or increased rates.
Before the Affordable Care Act was implemented, insurers could refuse coverage or charge higher premiums for pre-existing conditions in individual and small group markets. Now, however, this practice has been banned through Marketplace plans, although non-ACA compliant plans may still impose waiting periods or limit coverage in some instances; check each plan’s network to make sure your preferred doctors are included in it.
6. Out-of-pocket Costs
The cost of healthcare services should be an essential factor when determining which health insurance coverage best meets your needs. Review plan details such as deductibles, copayments, and coinsurance to make an informed decision before making your selection.
A deductible is the out-of-pocket expense you must cover before insurance begins covering medical services, while copayments and coinsurance payments count toward that deductible. Once your deductible has been met, coinsurance covers a percentage of services; out-of-pocket expenses can be limited with an annual maximum out-of-pocket limit.
7. Preventive Care
Preventive care is one of the cornerstones of better health outcomes, including annual or regular medical checkups, immunizations, and screenings to detect diseases based on age and risk factors. Preventive care can save money and improve health by detecting potential issues before they worsen. Many insurance plans cover preventive care 100% without any deductible or copay fees for coverage.
When choosing a plan, be sure to consider which doctors you have access to through that particular plan, and compare deductible and coinsurance rates to find an option that meets all your healthcare needs.
8. Mental Health Care
Treatment for mental health issues is integral to improving both physical and emotional well-being, which is why the Affordable Care Act mandates health insurance providers provide coverage for mental health services.
Finding an appropriate mental health insurance plan depends on your unique needs, budget, and benefits coverage. By considering all these elements carefully, you may be able to locate affordable plans available through the Affordable Care Act Marketplace that include mental health coverage. Rula makes it easy for you to connect with licensed therapists who accept your insurance, giving you access to help that fits within your coverage. This approach ensures that you are not wasting any of your insurance benefits!
9. Dental Care
Your ideal dental insurance depends on your family’s oral health needs, budget, and history with dentistry. When researching plans, pay particular attention to coverage options such as network options and waiting periods for basic and major services.
Find out about each plan’s annual maximums, copayments and deductibles; ask which plans your dentist accepts; check the Marketplace for costs and networks of each plan; Most Marketplace health plans offer dental and vision benefits; some don’t.
