Health insurance is designed to help you pay for serious health-related costs as well as preventative care, but navigating the different plans and prices can be overwhelming.
You may wonder, "what kind of health insurance do I need?" as you shop the marketplace and the vast array of insurance providers.
Before you commit to a health insurance plan, read on to learn more about what to look for so you're able to make the right choice for your unique needs.
Determine Your Marketplace
The type of health insurance plans you're eligible for largely depend on the marketplace from which you shop for them. In other words, many people get health insurance from an employer, while others shop through government exchanges.
If you're a full-time employee with benefits, your company provides you with the marketplace. For business owners and the self-employed, the government may offer you choices via the exchange.
You don't necessarily have to choose the health insurance plan your employee offers. If you wish, you can select a plan from an alternative exchange, but keep in mind that many plans in the marketplace are more costly than employer-offered options.
Some people may have a job that doesn't provide health insurance, such as many small businesses or companies only paying part-time hours to employees. If this applies to you, you can still look for coverage through the federal marketplace.
Make sure you know about the best health insurance companies so you're choosing a plan that will serve your needs in the most effective way. You can also go to the government's healthcare website and enter your information during open enrollment.
If you choose the government exchange, you may be directed to the state exchange first. If nothing is available, you'll be directed to use the federal marketplace instead. As a reminder, plans purchased through a private exchange are not eligible for premium tax credits, but government plans are.
What Kind of Health Insurance Do I Need for Myself and My Family?
Once you've done some shopping in the marketplace, you'll need to determine what kind of plan you need in order to get the best coverage. All of the acronyms can become quite confusing if you don't know what they mean. Some examples of plans include HMO, PPO, EPO, or POS.
Look at each of these types of plans and be aware of the summary of benefits. Most reputable online marketplaces should give you a link to a detailed summary including the cost. The type of plan you choose will determine your final out-of-pocket cost for premiums and deductibles.
It's also a good idea to examine the plan's network directory so you know which doctors and clinics in your area participate in the plan. Ask your employer or HR department for a summary of benefits if you're getting coverage through your job.
As you take a closer look at the different plans available, you're probably still wondering, "what kind of health insurance do I need?" Look at each type of plan carefully and be aware of whether or not you need to stay in-network and if you need referrals for special procedures and treatments.
Think carefully about you and your family's medical needs, and about any treatments you may have received prior. If someone in your family has health issues, you may need to increase your level of coverage.
An HMO or POS plan requires referrals which means you'll need to see your primary care physician first. Once you visit your PCP, they will then refer you to a specialist for more extensive care. Because HMOs have more restrictions, they tend to cost less than other plans.
If you're OK with your primary doctor choosing specialists for you, an HMO or POS plan should be fine for your needs. You won't need to do a lot of legwork since the doctor and staff will coordinate all of your visits and medical records.
For those with a POS plan, be sure to stay within your network if you can. If you need to go out of network, make sure your doctor gives you the referral ahead of time to help you save money.]
Patients who prefer to choose their own specialists will probably prefer a PPO or EPO plan. The EPO plan offers low costs if you stick with providers in your network. A PPO is ideal for those living in rural areas who have much more limited access to doctors and specialist care.
Aside from the available network and type of plan, your out-of-pocket costs are likely a major concern. The summary of benefits should show you exactly how much you're expected to pay out of pocket for most services.
Try to narrow down your choices based on these costs to make things easier for you. Plans that pay more of your medical costs will typically charge higher premiums.
If you need to see a PCP or a specialist fairly often, a plan with a higher premium could be financially beneficial. It's also recommended for those who frequently need emergency medical care, or for those who take expensive medications regularly.
Women who are expecting a baby or those with small children may also prefer a plan with a higher premium. This coverage is also better for anyone who is expecting major surgery or who has been diagnosed with chronic conditions like cancer or diabetes.
If you're young and healthy, a plan with lower premiums might be better for you. People who rarely need to see a doctor or who are single with no children may also benefit from a plan with lower out-of-pocket costs.
Find the Coverage That's Right for You
Asking "what kind of health insurance do I need?" can be tough to answer, but with a bit of research, you should be able to choose a plan that meets your needs. Take your time and talk to your employer about any coverage they offer to help you save money.
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