What's the best health insurance plan for me?
Choosing between different health insurance plans isn't always easy, and finding the “perfect” plan may be impossible for some people. In order to help you answer this question, here are a few things to consider:
15 Things to Consider While Comparing Health Plans
1. Long-term vs. Short-term Coverage
If you're between jobs for 1-6 months, you may want to look into short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and benefits offered by individual or family health insurance plan which will provide longer term coverage.
2. Basic vs. Comprehensive Coverage
Some insurance plans offer basic coverage that cover you in the event of a major accident or illness. These plans typically have lower monthly premiums than plans with more comprehensive coverage, and may be appropriate if you intend to use your health insurance primarily in the event of a serious accident or illness.
Other plans offer more comprehensive coverage which may include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits, in addition to coverage in the event of a major accident or illness. These plans usually have higher monthly premiums and may be appropriate if you intend to use your insurance on a regular basis.
3. Paying For Services Before or After You Use Them
The higher your monthly premiums the less you will pay per doctor visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you're likely to have a higher co-payment or deductible. If you don't anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.
4. Out-Of-Pocket Maximums
Health insurance plans often place a limit on how much you are required to pay out per year for your healthcare. This limit is often referred to as an out-of-pocket maximum. Once you've contributed this maximum amount toward your healthcare, the health insurance company usually covers all other costs for the remainder of the benefit year. If you're concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you're considering.
5. Costs
Find out what deductibles you will need to pay first before the healthcare dollars kick in. Find out if your deductible needs to be met before any services can be used. Also, find out what percent the health plan will pay after your deductible, as well what percent they will pay if you need to use a doctor, hospital, or specialist that is out of network. In addition, you will want to know what your co-payments are. Co-payments are the fees you need to pay when visiting your doctor, hospital, or emergency room. Finally, know your limits. Some plans have lifetime limits on how much the health care plan will pay and some have lifetime limits and yearly limits.
6. Your Preferred Doctors or Hospitals
Some insurance plans use provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be within the network of your chosen health insurance plan.
7. Physicals and Health Screenings
If you require regular physicals and health screenings, make sure these are covered. Most managed care plans cover these types of screenings yearly, but some independent insurance plans do not cover them at all. If you have children find out if well-baby check-ups and immunizations are covered.
8. OB-GYN
If you see an Obstetrician or Gynecologist regularly, find out if your doctor is covered in the plan you are considering, and make sure you review all the same conditions mentioned in Doctors, above. Also, if you are considering fertility treatments or will in the future, check what may be covered as some plans are now including varying types of fertility coverage. The same goes with pregnancy coverage; find out how much you will have to pay out-of-pocket for pregnancy and birth care if you are pregnant or decide to get pregnant in the future.
9. Additional Services
Consider what additional services are covered when comparing health plans. Some examples of additional services that may be important to you include: drug and alcohol rehabilitation, mental health care, counseling, home health care, nursing home care, hospice, experimental treatments, alternative treatments, chiropractic care.
10. Specialists
If you have specific medical conditions, or believe you may need to see specialists in the future, find out how you will be able to use a specialist. Check to see if you will need to contact your primary care physician first. Also, if you currently use a specialist, find out if they are in the network of the health plan you are considering choosing.
11. Pre-Existing Conditions
Coverage for pre-existing conditions may vary between plans, from being excluded, being covered fully, or being covered only after a specific period of time. The Health Insurance Portability and Accountability Act (HIPAA) ensures coverage for pre-existing conditions if you are joining a new group plan from your employer and you were insured the previous twelve months.
12. Emergency and Hospital Care
Find out what emergency rooms and hospitals are covered in your plan. In addition, find out what constitutes an “emergency.” Sometimes your definition of an emergency may not be the same as the health care plan you are considering. Also, check to see if you need to contact your primary care physician first before getting emergency care.
13. Prescription Drug Coverage
If you use prescription drugs regularly, or think you may in the future, consider a health plan that has prescription drug coverage. This coverage type can vary greatly from plan to plan. Variations can include no coverage to complete coverage and everywhere in-between, like varying co-pays for different types of drugs. If you cannot get your prescriptions in a generic form, find out first what price you will pay for your prescriptions.
14. Exclusions
The last consideration is the exclusions list. Review each plan’s exclusions list to find out what is not covered and to see if any condition you currently have, or expect to have in the future, is included on that list.
15. Financial Incentives and/or Tax Advantages
If you require financial incentives and/or tax advantages as part of your health insurance, an HSA plan may be a good choice. An HSA is a tax-favored savings account that can be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses. Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
Contributions to an HSA may be made pre-tax, up to certain annual limits. Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free. Not all high-deductible plans are eligible for use in conjunction with an HSA.