Affordable Health Insurance: Your Buying Guide

Having health insurance is crucial for everyone. As an individual and as a family, being without health insurance can be a disaster in many ways, It can mean the inability to access the kind of quality healthcare you need at any point in time, but it can also mean that you’ll be drained financially by having to spend out of your own pocket to access quality healthcare.

As a result, time is of the essence when it comes to getting the best health insurance plan for you because the very essence of insurance is that you cannot be certain exactly when you’ll be needing it. Despite that, it’s important not to rush off and get just any plan because there are many significant differences between the plans and getting the wrong one can be even worse in many ways, Here is a guide to help you decide what is best to you and to buy the plan that suits (read: protects) you and your family perfectly:

Which Health Plan Marketplace?

If you are employed in a place where health insurance is one of the benefits, you will be getting your insurance through your employer and won’t have to deal with government insurance exchanges or marketplaces. If you want to get an alternative plan in the exchanges, you can, although they are likely to be more expensive as a result of the fact that most employers contribute to their employee’s premiums, and the premiums are generally lower, to begin with.

If you want to get insurance outside your employer or if your workplace doesn’t provide health insurance, you’ll need to confirm if your state has an insurance marketplace. If they don’t, you’ll have to use the federal marketplace, a private exchange, or buy directly from an insurer.

What Type of Plan?

There are four major types of plans that you’ll get to choose from as you search:

  1. HMO: Health Maintenance Organization
  2. PPO: Preferred Provider Organization
  3. EPO: Exclusive Provider Organization
  4. POS: Point of Service Plan

The differences between them are extensive, but the most significant ones are how much they cost, whether they require you to stay in-network in order to get coverage and whether you’ll need to get a referral to be able to access a specialist or get certain procedures. Some also offer a primary doctor who supervises your care and the amount of freedom you have to choose providers also differs – a PPO or EPO are generally the most flexible in this regard.

In choosing the type of plan to sign up for, you’ll need to evaluate what your needs are likely to be, in terms of how much traveling you do (which will impact the likelihood of going off-network). Consider the kind of treatment you’ve needed in the past, as it’ll help you understand if easier access to specialist treatment should be a priority. One way to cut through all the confusing calculations is to work with expert insurance advisors who will be able to take all your information, analyze your needs using their experience in the field and guide you to the best type of plan for you. You’ll save time and money in the long run, and you’ll be sure of having the best type of plan for your family’s needs.

What Health Plan Network?

The way health insurance networks work is that the health providers in a network have arrangements with one another for lower costs to be paid for the services they provide. This means that as a health insurance holder if you go to a doctor who is in the network, the costs will be significantly lower than going to a doctor that’s outside the network because those ones don’t have pre-agreed rates. That will result in you having to pay a higher amount as contributions.

There are two ways to approach this. The first is if you have doctors whom you have been seeing and whom you would like to keep going. You can ask them for the plans they accept and use those as a shortlist to make your final choice. It’s important to keep in mind, however, that the relationship between the doctor and the network may not last forever, and your preference for them (and the convenience of visiting them) may not be permanent either. So, it’s better to ensure that your network of choice affords you some flexibility, which is the second approach – looking for a large network that gives you more options. People who live in rural areas will particularly benefit from large networks because the likelihood of finding a doctor who accepts your plan will be much higher.

What Are the Benefits?

While having a health insurance plan is good, generally speaking, it must be a plan that covers what you actually need. Check the benefits offered in your plan to see what they cover and if any special needs you have might be included. For instance, do they cover the specific conditions or treatments that you’ll likely need? Mental health care? Physical therapy? Maternity services? What if you get sick while you are one a trip outside the country?

Be sure to check thoroughly and if necessary, get in touch with the provider to ger clarification. Take notes to be sure you get a full understanding of the extent of the plan’s coverage. Here’s another area where having an expert insurance advisor would be a great boost – they’ll be able to tell you exactly what’s covered and not covered in the plan you’re considering, to be sure you don’t make the mistake of signing up for a plan and then having to pay for an expensive procedure all by yourself because it is not covered in your health insurance plan.

How much Are The Out of Pocket Costs?

Although you need to read the fine print in every aspect of your health insurance plan, the out of pockets section is one that you need to read twice, thrice or as many times as it takes to be sure you fully understand how much you’ll be expected to contribute to your healthcare expenses. The feral marketplace and many state marketplaces usually provide previews of how much these costs are relative to one another.

You’ll need to understand what deductibles, co-payments, and coinsurance are, to be sure you can correctly parse what you’re reading. The general rule is that the lower you are going to be paying as premium, the higher you’ll pay as out of pocket costs. There’s usually a cap on what you can be liable to pay out of pocket costs, so be sure to verify that as well from the plan documentation.

If you only have to see a doctor rarely, it might be a good idea to have a plan with a lower premium but increased out of pocket costs. Conversely, if you are likely to need costly treatment such as giving birth, surgery, emergency care, or expensive, brand-name medication, having lower out of pocket costs might be the best thing for you even if you have to pay higher premiums.

If you’re in need of health insurance or looking at switching providers feel free to reach out to our professional agents and see what health insurance program might be right for you, that can help you through this time.  Call Vivna, Inc. today to learn more here: 866.793.2301