How To Pick A Health Insurance Plan That Works For You
Agnus Smith | Published: June 14, 2018
Say you go to the hospital for a broken leg. You have X-rays taken, a cast fitted, and crutches purchased so you can get around for the next few months.
It's a painful and tedious process, but for many, the worst part of this ordeal happens long after they've left the hospital -- when they receive the enormous hospital bill in the mail. After you've suffered from the high cost of an unexpected injury, you wish you had a health insurance plan that helped pay for it.
Or say you've been prescribed medication for an illness or ongoing condition, but your plan doesn't cover that brand-name drug. Now you'd give anything for a plan that didn't make you pay full price for such an expensive medication.
Or perhaps you just don't like your doctor. Or you're unhappy with your employer-sponsored coverage.
Whatever the reason for disliking your current plan, you've decided to find a new one. But where do you look, and how do you know what to look for in a new plan?
Search For A Plan In 7 Steps
Insurance plans help you with your ongoing medical needs and protect you from the high cost of care for major accidents or illness. But the plan that works for your neighbor might not work for you. Insurance providers design plans so that their varied coverage options serve the diverse needs of people buying them.
To find the best plan for you, decide what services you need to be covered, what services you want to be covered, and what services you can do without. From there, you can balance the cost of those services with what you're willing to pay for a healthcare plan.
Follow this 7-step process to narrow your options, and get health insurance coverage that works for you.
1) Change What You Don't Like
If you're frustrated by your current plan, figure out which parts of it make you so unhappy. Are you paying too much for services you don't need? Do you want more coverage for services you do need? Do you distrust your insurance provider or doctor? Make a list of things you dislike about your plan, and look for options that address those issues.
2) Keep What You Do Like
Say you hate your plan, but you love your doctor. Or you want to change plans, but you want the same hospital, clinic, or specialists you're used to visiting. Just because you change plans doesn't mean you have to change doctors or healthcare facilities.
Before you start looking at your options, make a list of the healthcare providers you want to keep using. Find out which networks those doctors are part of, and search for plans that include those networks. If you pick a plan with a network that doesn't include the doctors you want, you'll pay much more to see them than if you choose to see in-network doctors instead.
Because verifying networks can be confusing, double-check with an expert. First Quote Health will direct you to a licensed agent who will determine if your preferred doctors accept any of the plans you're considering.
3) Decide What Medications You Need Covered
Although prescription drug coverage is required for all ACA-compliant health plans, plans vary in how they help pay for prescription medications. So, just like you made a list of doctors you want to keep seeing, compile a list of medications you're currently using. Look at a plan's formulary to see which medications it covers, and make sure your required medications are included on that list. If you need multiple medications, go for a plan that has the most generous coverage for prescription drugs.
4) Decide What Services You Want Covered
After you’ve figured out how to keep a doctor or cover your prescriptions, evaluate what other services you want included in your plan. Here are some suggestions for needs you might have:
- You feel relatively healthy, and you rarely seek medical care: Look for a cheap plan with the most basic coverage. That way you can avoid paying extra for services you don't care about.
- You make regular doctor visits: Go for a plan that doesn't charge you much for each visit (in the form of a copay).
- You travel a lot: You want a plan that allows you to go out-of-network in case you have an emergency while away from home. A PPO plan allows you to seek care outside your network.
- You have a chronic condition: Find a plan that helps pay for your medications, visits to specialists, and any screenings, lab tests, and check-ups that help you manage your condition.
- You are expecting a major life change: If you're expecting a child, you'll want generous coverage for maternity care.
- You are prone to illness or injury, or you want to be covered in case of emergency: Pick a plan that limits your out-of-pocket costs for hospital visits.
- You aren't dealing with major illnesses now, but you have a family history of certain diseases or conditions: Look for healthcare coverage that encourages preventive care. (HMO plans typically emphasize preventive care more than PPO plans.) For instance, if you have a family history of heart disease, find a plan that covers cholesterol-lowering drugs or heart-health screening tests.
If you want to include a spouse and/or dependents in your plan, be sure to evaluate which services they'll want or need.
5) Sort Through Your Plan Options
Think of a health insurance plan as a set of rules that dictate where you can go for a medical service, and what portion of your healthcare costs you'll be expected to pay. Within each plan type, you can choose from different sets of healthcare provider networks, and different rates for premiums and out-of-pocket expenses.
The two most common plan types are HMO and PPO plans. Generally, an HMO plan is the cheapest option because you have a limited network of providers. A PPO plan is typically more expensive because you have greater freedom in choosing which doctors and hospitals you visit.
Within these plan types, you can pick a plan based on how much you want to pay in premiums vs. out-of-pocket costs. Typically, the less you pay in premiums, the more you pay in out-of-pocket costs, and vice versa. To make plans' cost differences easier to compare, ACA-compliant plans have been ranked into “metal” tiers. You can choose a plan from the Bronze, Silver, Bronze, or Platinum category, depending on how much you want to share the cost of medical care with an insurance provider.
6) Find Out What You Have To Pay (And Don’t Pay More Than That)
Once you've narrowed your options to a couple plans, look at each plan's Summary of Benefits and Coverage. This standardized form is required by law for each health plan so that you can more easily compare each plan's differences. The summary lists covered benefits, coverage limitations, and a breakdown of out-of-pocket expenses. Knowing a plan's cost and coverage limits will help you choose one that only makes you pay for services you want or need.
7) Consult With The Experts
When you're searching for health insurance, you can look to one insurance company to provide coverage options. But if you want to compare healthcare plans from more than one company, look for plans offered by licensed agents. These agents represent multiple insurance companies, so you're more likely to find the best plan for you.
To get in touch with a licensed agent, try a website called First Quote Health. First, you'll be delivered quotes for available plans in your area. Then you'll get a call from an expert insurance agent. This agent will guide you through the process of comparing, selecting, and applying for a health plan.
Now's The Time To Pick A Plan!
The more you know about your plan options, the more likely you are to save money. With careful research and expert advice, you'll find great coverage that fits your health and budget. So go ahead -- start your search today!