Evaluating Your Health Insurance Plan: What to Look For
The United States is one of the most expensive countries in the world regarding healthcare costs. In 2021, healthcare spending reached $4.3 trillion. That's the same as $12,900 per person every year. The health insurance plan you pick is vital for cutting costs and providing ample coverage for your various medical needs. However, you need to make sure you're paying for the best one available.
Here are a few steps to follow when choosing health insurance and comparing your options.
Identifying Your Needs
The first step to finding health insurance coverage is identifying your current needs. What type of coverage will you require for the next year or so? Is it worth paying more for better coverage in case of emergencies?
At the bare minimum, you want to purchase insurance that works with your primary care physician and covers the costs of your current medications. You should only change insurance plans if you get a better deal for at least the same level of coverage.
You should also look into sufficient supplemental insurance that covers dental and vision insurance. Even if you don't need something like a root canal or a crown soon, having relevant insurance could save you hundreds of dollars.
One of the biggest struggles when it comes to evaluating your insurance plan is comparing it with others either within your provider or outside of it. You may find something more affordable with equivalent coverage. Alternatively, upgrading to a more expensive plan could save money on your healthcare expenses later.
There's also the debate between HMO and PPO plans. Both offer access to a network of doctors but have their limitations.
An HMO offers low or no deductibles and lower premiums. Although they're more affordable, they require a referral for specialists and do not cover medical expenses outside of your plan's network.
A PPO offers much more freedom but has higher premiums. You may also get coverage outside of your plan's network.
Some important information to understand when you look into your insurance coverage is what all the various numbers mean. You have deductibles, coinsurance, copays, and out-of-pocket maximums that all determine what kind of coverage you receive and how the insurance functions.
A deductible is the amount of money you must pay before your policy starts providing coverage. In many cases, plans with higher deductibles cost less monthly but only help your payments once you've covered a certain amount yourself.
Your coinsurance cost is the amount you pay after insurance covers its portion. It may be 20%, while insurance pays 80%.
A copay is a preset amount you pay for prescriptions or doctor visits.
Your out-of-pocket maximum is the most you must pay for your covered services annually. Your deductibles, copay, and coinsurance all go towards this number. Once it's maxed out, you won't have to pay for any other benefits.
A lower copay or coinsurance saves you money, but a higher one means you may meet your out-of-pocket maximum sooner.
Look at the various costs associated with your insurance plan. Based on your premium and copay/coinsurance, are you saving as much money as you think?
In some cases, insurance companies will charge you low premiums in exchange for high coinsurance rates. This is fine if you never visit the hospital, but it can cause huge costs if you have frequent medical appointments.
Conversely, higher premiums may be worth it if you have much smaller copays or coinsurance. You'll pay less for your visits and medications that way.
Considering Specialty Care
You may want to explore plans that offer specialty care, such as mental health, dental, and vision.
At the very least, most health insurance plans cover mental health services. This includes visits to a therapist or psychiatrist and medication like antidepressants and anti-anxiety pills.
Unfortunately, these plans only sometimes cover dental or vision. You'll need to look for supplemental plans offered by the same provider or another company. You can get included coverage if your doctor refers you to a specialist for a mouth or eye disease, but it depends on the insurance.
It's also worth looking into coverage for alternative medicines, such as chiropractic therapy. Your insurance company may cover them if your PCP refers you to one.
Making Your Decision
Once you've analyzed your current plan and other policies, you'll need to decide which is best for your specific needs. Does your plan provide sufficient coverage for your routine medical visits and medications? Would you save money by switching to another plan, and is it worth the trouble?
It may help to keep a checklist of the most important factors, such as whether or not your medication is covered. You can also call the insurance company to speak to a representative if you have any questions about their coverage.
Finally, remember that open enrollment is the best time to change your insurance plan. That's between November 1 and December 15. Some plans will let you upgrade or change them mid-year, but those are for special circumstances.
Find the Best Health Insurance Plan
Comparing health insurance plans is always a challenging task. There are many variables to look out for, but it's worth it if you want to save money and get better coverage. Your health insurance plan is your lifeline in this country, where medical bills can run notably high.
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Jay Todtenbier is an original founder of SupplementRelief.com in 2010 and has operated the business ever since. He is also a tennis instructor and gospel musician. Formerly he spent 25 years in business development, technology and marketing with startups and major corporations having gone through the tech boom in Silicon Valley in the 90s. He became passionate about, and began studying and practicing Wellness as a Lifestyle after experiencing chronic, personal health challenges including depression, auto-immune disorders, and being overweight that impacted his ability to live a healthy, vibrant life. Since then, he has been an advocate for healthier living encouraging others to live better through making small, gradual changes to lifestyle behaviors relating to whole-foods nutrition, stress management, reasonable exercise, proper sleep, and the use of targeted, high-quality supplements.
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The information, knowledge, and experience shared on this website is the opinion of SupplementRelief.com. This site and its content is intended to enhance your knowledge base as YOU MAKE YOUR OWN HEALTHCARE DECISIONS in partnership with your qualified health professional. These statements have not been evaluated by the Food and Drug Administration. Any products referred to are not intended to diagnose, treat, cure or prevent any disease.
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