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Pick a Health Insurance Plan

How to Pick a Health Insurance Plan

by Jennifer Ryan

Today, health insurance is vital. Considering the rising cost of health care and prescription drugs, it is very hard to get by without some sort of health insurance. Unfortunately, it can be very difficult to find and pick a health insurance plan that best suits you and your family’s needs. Not only do you have to understand the details of the coverage, but you also need to make sure you can afford it. Plus, there are a ton of factors you must consider.

Here, we will review some questions that you can ask yourself to help you pick a health insurance plan.

Health Insurance Plan Coverage

The first step when you pick a health insurance plan is to understand what the plan covers. There are a ton of different plans that offer different levels of coverage. It is imperative you find one that suits you and your family’s needs. When you pick a health insurance plan, you may want to see if it covers items such as:

  • In-patient care
  • Outpatient care
  • Lab tests
  • Emergency services
  • Pediatric services
  • Vision
  • Dental
  • Prescription drugs

Some plans also offer coverage for mental health support, substance abuse treatment, cancer treatment, rehabilitation services, as well as pregnancy.

If the plan you are thinking about selecting doesn’t cover at least half of these items, considering looking into a better plan.

Personal and Family Health Requirements

Not all plans are the same. When you try to pick a health insurance plan best for you and other plan beneficiaries, take a close look at your personal medical history. Understanding your health requirements or how often you’re likely to visit the hospital can help you determine which coverage is suitable for you.

If you are relatively healthy and rarely go to the doctor, a simple plan should be suitable for you. However, if you rely on the services of specialty doctors, make sure your plan covers this. An example can be gastrointestinal doctors, ear nose and throat doctors (ENT) if you have upper respiratory problems or allergies, or OBGYN services. If you or your family has a history of chronic illness, make sure you consider this as well.

Depending on the level of coverage you need, you will have to pick a plan that suits you but also make sure you can afford it.

Plan Costs

One of the most complicated aspects of health insurance are the costs associated with it. You will need to understand monthly premiums, copayment amounts, coinsurance, deductibles, as well as out of pocket maximums. Here, we will take a more detailed look at these expenses.

A health insurance premium is the amount that you pay for your health insurance plan. In most cases, you will pay this monthly. If you have health insurance through your employer, your premium will be taken out of each your paychecks. If you get paid twice a month, you will pay half of your monthly health insurance premium each time you get paid. Each employer may do things differently, but this is a very popular method. If you’re in good health or you don’t have a chronic illness that requires you to be in a hospital from time to time, you may want to choose a plan with a low premium.

A plan with a low premium has low monthly costs. However, you will have to pay more for almost all doctor’s visits and prescriptions until you hit a certain threshold. This threshold amount is a deductible. After hitting the deductible, you should get full coverage. Some plans have out of pocket maximums, as well as maximum coverages for certain types of procedures.

Out-of-pocket costs comprise copayments, coinsurance, and deductibles. Typically, coverage with lower out-of-pocket costs attract higher premiums.

Depending on your healthcare requirements, you’ll be able to choose the right balance between premiums and out-of-pocket costs. If you don’t require regular visits to the hospital, a low monthly premium might be what you need, and vice versa.

Before you settle on and pick a health insurance plan, be sure you understand the cost.

Will you be able to afford it if you are sick?

Imagine this; you come down with a condition that requires you to be hospitalized for quite some time. Maybe, your partner requires some prescriptions, and your child has to get braces. What happens next? Will your insurance cover all of these bills?

Most people never think of such a situation. It would help to know how much will be paid by the health insurance and how much you’ll pay from your pocket. One thing that may help in a medical emergency is having funds available. This can be very helpful to lessen the burden of unexpected medical bills. Here are several tips to build an emergency fund.

No matter what plan you choose, you’ll want once that offers a fair share of protection without exhausting your savings.

What doctors can you go to?

Another detail associated with a health insurance plan are the doctors you are ‘allowed’ to go to. Do you and your family have certain doctors you have gone to in the past that you really want to still use? If so, be sure that your insurance provider covers the services from these doctors.

Many insurance plans are restrictive when it comes to the doctors you can see. When a doctor, hospital or other provider accepts your health insurance plan they’re in network. They are also known as participating providers. When you go to a doctor or provider who doesn’t take your plan, we say they’re out of network. If your go-to doctor is out of network, you insurance plan may only cover a portion of their bill, or in some cases not cover any part of it.

This is why it is very important to see which doctors and covered under your plan when you are trying to pick a health insurance plan.

How to Pick a Health Insurance Plan – Summary

As you can see, there are a ton of factors you must consider when you pick a health insurance plan. Selecting the best health insurance plan for you and your family is not easy. You will need to take things into consideration including coverage, health requirements and history, as well as plan costs. It is also important to determine if the doctors you like to see are in or out of network, as this can affect the amount you will ultimately end up paying.

If you need to find out more information about your plan before you pick it, be sure to reference the plan’s Summary of Benefits and Coverage documents. This resource will provide you will all the plan details you need to know about. If you are getting a plan through your job, someone in your HR department may be able to answer any remaining questions you have.

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