How to Choose Health Insurance: Your Step-by-Step Guide

  • Leader
    October 1, 2022 2:37 PM PDT
    You usually have limited time to choose the best health insurance for your family. However, if you rush and choose the wrong coverage, it can be costly. Here's a guide to help you find affordable health insurance, whether through a state or federal marketplace or through an employer.

    Step 1: Choose your health insurance marketplace.

    How you choose health insurance depends on what's available to you.

    If your employer offers health insurance

    Most people who have health insurance get it through their employer. If your employer offers health insurance, you don't have to go to the state insurance exchanges or marketplaces unless you want to shop around for an alternative plan. However, marketplace plans are likely to be more expensive than employer-provided plans. That's because most employers cover a portion of their employees' insurance premiums.

    If your employer doesn't offer health insurance

    Search your state's online marketplace (if available) or the federal marketplace for the best plan for you. Start by going to HealthCare.gov and entering your ZIP code. You will then be directed to your state's exchange, if there is one. Otherwise, use the federal marketplace.

    You can also purchase your health insurance or get [url=https://insurancenyou.com]health insurance quote[/url] through a private exchange or directly from an insurer. If you choose these options, you will not be eligible for premium tax credits, which are income-based discounts on your monthly premiums.

    Step 2: Compare types of health insurance plans.

    When searching for the best health insurance plan, you'll come across an alphabet soup. The most common types of health insurance plans are HMOs, PPOs, EPOs and POS plans. The insurance plan you choose will determine what costs you have to pay yourself and what doctors you can see.

    Look for a summary of benefits

    Online marketplaces for [url=https://insurancenyou.com]Medicaid quote[/url] usually provide a link to a summary of benefits that explains all of the plan's costs and benefits. A provider directory listing the doctors and clinics that participate in the plan's network should also be available. If you purchase coverage through your employer, ask your caseworker at work for the summary of benefits.

    Check your family's medical needs.

    Look at the amount and type of treatment you have received in the past. While it's impossible to predict all medical costs, knowing the trends will help you make an informed decision.

    Consider whether you want a referral system for care

    Plans that require referrals

    If you choose an HMO or POS plan that requires a referral, you'll usually need to see a primary care physician before you can make an appointment for a procedure or visit with a specialist. For this reason, many people prefer other plans. However, by limiting your choices to the providers they contract with, HMOs are usually the cheapest type of health insurance.

    Plans that don't require referrals

    If you prefer to see specialists without a referral, you may be better served with an EPO or a PPO (EPOs generally don't require a referral, but in some cases you should read the fine print). With an EPO, you can keep costs down as long as you find providers who are part of the network; this is more likely to be the case in a larger metropolitan area. If you live in a remote or rural area with limited access to doctors and medical care, a PPO plan may be better, as you may then be forced to seek care out-of-network.

    Step 3: Compare health insurance networks

    Your health insurance "network" refers to the medical providers and facilities your health plan contracts with for your care.

    Why is the network important?

    Costs are lower when you go to a doctor who is in the network because health insurance companies negotiate lower rates with providers who are in the network. If you go to a doctor outside the network, those doctors do not have agreed-upon rates, and you usually have to pay a higher share of the cost yourself.

    Do you have preferred doctors?

    If you want to continue seeing your current doctors, make sure they are listed in the provider directories of the insurance plan you are considering. You can also ask your doctors directly if they accept a particular health plan.

    Is a large network important?

    If you don't have a preferred doctor, it's probably a good idea to look for a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, as you'll have a better chance of finding a local doctor who will accept your plan.

    Step 4: Compare out-of-pocket costs.

    Out-of-pocket costs (i.e., costs beyond the monthly premium) are another important consideration. A plan's benefit summary should clearly show how much you'll have to pay out-of-pocket for services. The nationwide online marketplace offers snapshots of these costs for comparison, as do many state marketplaces.

    Step 5: Compare benefits.

    At this step, you will likely have narrowed down your options to a few plans. Here are some things to consider next:

    Check the scope of benefits

    Look at the summary of benefits to see if any of the plans cover a broader range of services. Some plans may better cover things like physical therapy, fertility treatments or psychiatric care, while others may offer better emergency care.