Blog > Health Insurance Guide
Choosing the Best Health Insurance Plan: Step by Step
Finding a health insurance plan that best suits your needs can be complicated. There’s a lot to take into account: is this covered? Is that covered? HSA? HMO? What does it all mean and how can you find everything you need and nothing that you don’t? At Kaufman Insurance, trust that you’ll find the best plan for you! Here’s a quick guide to help clear things up and why Kauffman Insurance is here to help! Looking for the right insurance plan for you? Contact us today!
Navigating the Marketplace
Before you get started, it’s important to know where your health insurance plan is coming from and what’s available. Being that over 155 million Americans under 65 have coverage, there’s a good chance that your insurance options are provided through your place of employment. Because of this, your marketplace is usually made available directly through them. Another option is the Affordable Care Act marketplace, if available in your current market. But even those options can be difficult to navigate when choosing plans for specialized care and even common coverage.
Comparing Insurance Types and Plans
Once you’ve found your marketplace it’s time to find and compare coverage. This is where you’ll encounter the first complications. PPOs, EPOs, POS, HMOs, HSAs – all the acronyms with few explanations into what they really are and how they benefit you. But still, each option should come with a summary of benefits that are right for you. While the actual search may include prices and more specific coverage, here’s a handy chart to get you started:
When comparing the variety of different plans you are faced with, it is important to take pay extra attention to your family’s medical needs. Chronic conditions, recovery from past conditions, a predisposition to illness, increased injury changes due to lifestyle choices and more should be taken into account. These factors are important when choosing the coverage that’s best for you.
A plan that requires a POS or HMO requires insurance holders to first see their primary care doctor BEFORE actually scheduling a procedure. This is also necessary when you have to see a specialist for a specific kind of care. This process can be cumbersome and is usually reserved for those who have more time to work with. This is also an option that may be best for those who would like their primary care physician to take care of all the details – they would choose your specialists and handle your medical file – this ultimately means less work on your end.
If you would like to make your own decisions regarding your treatment and which specialists you see through your own research, a PPO or EPO plan may be more your speed. If you can find a provider in your network, an EPO could keep your medical costs low. If you live in an area with rather limited healthcare options, a PPO could be a better option. Either way, both have their benefits.
In-Network vs Out-of-Network
You will hear phrases like “in-network” and “out-of-network” constantly. So, what does this mean for you? Generally, an in-network doctor/physician will be more affordable than one that’s out of network. This cost difference translates to a very important decision when choosing a plan. If you do not have a preference for a primary doctor or more to the point, if you don’t have access to many healthcare options, your best bet would be to find a plan that has a wide variety of choices.
Determine How Much You Will Pay
The initial cost of insurance can seem steep when coming from your pay, but there is more to consider than basic access. This brings us to out-of-pocket costs. It is important to note that these costs should not be hidden under any circumstances. When comparing these costs, keep in mind these terms that you will, without a doubt, encounter in your search:
Deductibles: The amount you pay out-of-pocket before your insurance covers your medical costs
Copayments: A rate that is predetermined by your health insurance plan at your time of care
Coinsurance: The percentage that you pay for medical care vs what your insurance will pay after you’ve met your deductible
There is a cap on how much you should pay out of pocket annually. This is a number that should be made available to you when selecting coverage. So, if your insurance premium (the rate of your actual insurance plan) is low, it could be because there is a higher deductible which means higher out-of-pocket costs.
Finally, we come to the benefits – the core of any good plan. This is where your hard work pays off and is crucial to receiving the best coverage for you. Once you have taken into account any chronic conditions, speak to a healthcare provider to determine what is and isn’t covered. Ask all the questions you need to ask to make sure you’ve covered all the bases. Questions worth asking:
Are maternity services covered? Which ones and to what extent?
I take “this” medication for “this” condition - is this covered under the plan? To what extent?
Will this insurance cover me when traveling overseas? What would it cover? How much will it cover?
Which documents will I need to get started? When does my plan start? How long am I covered?
How long before I reach a deductible?
This is the basic outline needed when finding the plan that works best for you. Confused? Don’t be! Experts at Kauffman Insurance Group are here to help! At Kauffman Insurance Group, we determine the best rate available between hundreds of carriers and our support service team is committed to helping you with all your insurance needs!
Contact us by calling (800) 881-2790 and speak with an expert today!