You want the best for your family. Unfortunately, when it comes to health insurance in the United States, it’s not always easy to get the insurance you need at a price you afford. A startling 28.5 million people, or 8% of the U.S. population, didn’t have health insurance in 2017.
From finding a plan to understanding the different terms and payments, choosing a health insurance plan for your family is complicated. This guide will tackle everything you need to know so you’re able to find a plan that suits your needs without breaking the bank.
1. Use Your Local Marketplace
First, you need to search for your health insurance options. Depending on your situation, you’ll have different resources available to you. If you’re employed full-time, you’ll likely have access to health insurance through your employer. There are a lot of perks to opting into a plan with your employer. Your employer actually covers a portion of the cost, and payments can be directly taken from your paychecks.
If you’re not able to get coverage through your employer because you’re self-employed, your employer doesn’t offer coverage, or you’re unemployed, don’t fret. There are options for you no matter your economic or employment situation.
Another alternative to “traditional” coverage is through the Affordable Care Act. You can search the Affordable Care Act marketplace on your state or federal government website, depending on your option. You’ll simply enter your zip code and be directed to a variety of plans in your area. Check here for the right plan for you.
If you don’t qualify for health insurance under the Affordable Care Act, you can still get coverage. You’ll just have to go directly through an insurance provider to get an independent plan, meaning you’re seeking coverage without an employer. Under this type of plan, you have access to the same benefits and the ability to add dependents. The main difference is that you won’t have the employer subsidies or income-based discounts.
2. Compare Different Plans
Next, once you’ve found your marketplace or researched employer coverage options, it’s time to compare plans to choose the right one for your needs. As soon as you jump into the insurance search, you’ll notice the complicated terms for every plan. These might feel a bit like reading another language, but they’re not as strange as they seem. Let’s break them down:
- Health Maintenance Organization (HMO) – With a HMO plan, you need to see an in-network provider to get coverage, and you’ll need a referral for specialist care. However, HMOs are generally lower cost so this is a good option for families that don’t expect to need many referrals.
- Preferred Provider Organization (PPO) – With a PPO plan, you don’t need to see an in-network healthcare provider, but you’ll get a discount if you do. You also don’t need a referral to see a specialist. PPO plans are a flexible option.
- Exclusive Provider Organization (EPO) – Though less common, EPOs only you to see in-network providers to get coverage. You don’t need a referral for any visits to specialists, so this is a little different than an HMO in that way.
- Point of Service Plan (POS) – Finally, with a POS plan, you can see both in-network and out-of-network health providers, but you’ll pay less for in-network providers. You’ll also need a referral from a network provider to see an on-of-network provider. A POS plan has more options in providers, though you’ll need to choose a primary doctor who coordinates care.
So which plan is right for you? Ultimately, it comes down to your family. Not every family needs to see specialists frequently, and in that case, you might be fine paying less for only a few in-network providers.
Start your search by considering what providers are near you. If you already have a doctor you want to continue seeing, make sure they’re covered under your plan. In addition, consider how much you’re willing to pay for services. If you’d rather pay more out-of-pocket and less in monthly premiums, an EPO is a good fit for your family. There is no right choice, just make sure you can see the doctors you need when you need them.
3. Compare Providers
Next, it’s time to compare providers. Different providers offer different plans, but not all providers are the same. If you’re getting insurance through your employer, you might not be able to choose a provider. However, if you’re choosing an independent plan, you’ll have your choice of providers available in your area.
The easiest way to compare providers is by looking at their networks. This is the list of doctors and specialists covered under their plans. Once again, if you already have a preferred doctor, you’ll want to make sure they’re included in the plan.
If you don’t already have a primary doctor, you’ll still need to consider the network. In this case, you likely want a large network of doctors to choose from so you’re able to find a doctor that works with you. A too-small network might be fine if you already know which doctor you plan to see, but otherwise, you might need to search more intensely.
4. Check the Cost
Of course, you’ll need to think about the cost. When you’ll looking at your insurance plan, dive deep into the different costs. Understanding these costs can be confusing if you’re not familiar with all of the terms. Here’s another breakdown of the important terms you need to know when checking the cost of your health insurance plan:
- Copayment – Also known as a “copay,” your copayment is how much you’ll need to pay for services. You’ll likely need to pay a copay for things like office visits, exams, and tests.
- Premium – Your premium is how much you pay every month to your provider to keep your plan active.
- Deductible – The deductible is how much you’ll need to pay towards your healthcare before your health insurance will begin to pay.
- Network – As we mentioned before, this is the list of providers, hospitals, and other specialists that are offered in your coverage plan.
- Coinsurance – Finally, your coinsurance is how much you’ll be expected to pay for services. This is calculated as a percentage. For things like exam visits and routine health checks, your coinsurance will probably be 0%. On the other hand, you might be expected to pay 20% of additional office visits.
These costs will help you understand how much insurance you can afford for your family. The most important terms to know are the premium and the coinsurance. How much will you need to pay every month? How much will you need to pay for services?
When thinking about cost, also consider how much healthcare you usually use in a year. While it’s impossible to 100% anticipate your health needs, if you only need office visits usually, you might not need to pay so much for your premium if you don’t expect to need extensive coverage.
In general, the more you pay in monthly premiums, the less you’ll pay out-of-pocket for services and vice versa. It’s up to you how much you’re comfortable paying and how much healthcare you expect your family to need.
You should likely choose a higher costing premium if any of the following are true for you or someone in your immediate family:
- You see specialists frequently
- You’ve needed emergency care in the recent past
- You take prescription medication regularly
- You have a baby, are planning on having a baby, or have small children
- You have a diagnosed chronic condition
While there is no one-size-fits-all when it comes to healthcare, make sure you’re getting enough coverage. Accidents and emergencies do happen, so do your best to manage your risks without blowing the cost of your insurance.
5. Add Additional Coverage
Many people are surprised to know that traditional health insurance doesn’t always come with all the supplements you need to get full coverage. For instance, most plans don’t include vision and dental coverage. If you want to make sure you’re fully covered, you’ll need to add supplemental coverage.
Common supplemental insurance includes dental insurance, vision insurance, travel insurance, disability insurance, and critical illness insurance. These plans cost less than traditional health insurance, and they’re a lifesaver if you find yourself in an unexpected situation or needing additional care.
Like traditional insurance, you can include dependents in this coverage as well. You can find these plans through your employer and also your health insurance provider. Make sure you choose things relating to your families needs.
Protect Your Health
Is your health protected by your insurance? Getting the right health insurance coverage isn’t optional. No matter how healthy you are, anything can happen in the future to your or one of your family members.
Protecting your health is a top priority, but health insurance isn’t always easy to understand. Now that you understand how to find and compare plans, it’s time to make a smart decision about your health. Get started with your search today so you’re ready for everything tomorrow has in store.
Also Read :