It’s no surprise that the health insurance landscape of today is complicated. It’s not easy to navigate, and this leads many individuals unsure of how to even begin their search for the right health plan. This guide will tackle step-by-step instructions for choosing a plan that works for you and your family. With options for federal programs or employers, as well as supplemental options, you want to make sure you understand your options every step of the way.
1. Understanding The Insurance Marketplace
There are two main types of insurance marketplaces you’ll be considering: your employer and the government marketplace. If your employer provides health insurance, this will be considered your marketplace. Your employer will offer different plans depending on your needs, and these will have their own restrictions and options.
If your employer doesn’t offer health insurance, if you’re unemployed, or if you’re self-employed, you can shop your state’s marketplace. These are offered through the Affordable Care Act. If your state doesn’t offer a comprehensive marketplace, you can search the federal marketplace. These options generally are more affordable or income-based. Visit the Healthcare Marketplace and insert your zip code to get started.
2. Understanding Insurance Plans
Next, it’s time to understand the ins and outs of these plans. The terminology and lingo aren’t always straightforward. In fact, it can be downright confusing if you aren’t familiar with insurance. There are different types of plans that offer different coverage options and payment terms. You’ll want to compare these alternatives to decide which makes the most sense for your situation.
- Health Maintenance Organization (HMO) – With a HMO, you have to stay within a network of providers to get full coverage. You’ll also need a referral to see an outside specialist. This is a good fit for those who want lower out-of-pocket costs and only plan to see a single primary care doctor.
- Preferred Provider Organization (PPO) – With a PPO, you don’t need to see in-network care, but you’ll receive cheaper prices if you do. This is a good choice if you need more provider options.
- Exclusive Provider Organization (EPO) – An EPO allows lower costs out-of-pocket, but you’ll need to see a single approved provider except for in the case of emergencies or if you get a referral.
- Point of Service Plan (POS) – With a POS plan, you receive more affordable care for in-network providers. This allows more freedom to see a variety of providers, but your primary doctor will need to coordinate your care.
The best way to understand which plan will work for you is to think about what you needed in the past. Is your family likely to only see the same doctor over the course of a single year? If so, then a HMO or EPO might be a good, low-cost option. On the other hand, if you expect to need specialist care, opt for a PPO or POS which allows more freedom.
3. Consider Extra Benefits
Not all insurance plans are created equal, as we saw above with the different plans compared. Most traditional health insurance plans only offer essential coverage for things like exams, office visits, and emergency care. They don’t usually cover outside medical options like dental insurance, vision insurance, or beyond.
While you might not need extra benefits, they’re often an affordable option for those who are expecting to need more coverage throughout the year. Even if you’re not sure what you need, these supplemental plans are often significantly more affordable than traditional insurance, thus worth the extra cost. Let’s examine the most common supplemental plans.
- Dental & Vision Insurance – These plans usually are combined to provide both vision and dental services like regular exams and medical treatment.
- Travel Insurance – Your traditional insurance coverage likely will not cover any services if you leave the country or sometimes even your state. Consider purchasing a low-cost travel insurance to stay covered when you’re outside of your network.
- Final Expense Insurance – No matter our plans, we all need to be prepared to make hard decisions about our own deaths. Final expense insurance can cover funeral expenses, medical bills, and other costs associated with burial, depending on the policy. For more information, review this guide: Final Expense Insurance explained by HealthMarkets.
- Indemnity Insurance – Traditional health insurance won’t cover all costs associated with your treatment, especially in emergencies. Indemnity insurance provides a set amount of money for qualified expenses which can make up for lost wages, extra costs, and other financial hardships.
These steps above prepare you to make smart choices about your own health coverage. It’s important to understand both the benefits and the limitations of your chosen plan. There’s no one-size-fits-all when it comes to healthcare. As long as you research and consider your families needs, you can feel confident in your choice.