November 13th, 2019 BY HealthNetwork
4 Things to Keep in Mind When Buying Health Insurance
Shopping for health insurance during open enrollment for 2019? Good. You should be. But maybe you’re like a lot of people and find the process overwhelming. With so many plans available on the market from different insurers, it can be tough to know what to pick and which company to go with. While all major medical plans cover the same essential benefits, not all cover those benefits to the same degree. There are plenty of things to consider as you’re looking for coverage, but here are seven things to keep in mind as you shop.
Networks play a big role in the health insurance industry. Some plans (mainly HMOs) only cover treatments and services that you get from in-network providers. That’s because they’ve contracted with these providers to reduce costs and offer lower rates to customers. Outside the network, no such deal exists. If you’ve got an HMO plan or you’re looking at one, know that your non-network providers and treatments won’t likely be covered unless it’s a true emergency.
PPO plans, on the other hand, typically offer some coverage for care from out-of-network providers, but it’s still much less than the coverage you’ll get from staying inside the network. If your providers matter to you, make sure they’re inside your plan’s network. Otherwise, you might have to pay more out of pocket (or the full cost) to see them.
The Costs (Not Just Premiums!)
When shopping for your next health insurance plan, you’ll probably note the cost (premium) first. But just because a plan has a low monthly premium doesn’t mean that it’s the most affordable plan for you and your family. This is because plans that have low monthly premiums often come with pretty high deductibles and out-of-pocket costs. Depending on the level of care you need, a low-premium plan might end up costing you much more out of pocket for the year, resulting in no savings vs. just getting a higher plan with lower cost sharing.
Instead of opting for the lowest premium option available, think about your upcoming healthcare needs and how much they’ll cost under each plan. Higher premium plans cost more upfront but less overall when you factor in your cost sharing (how much you’re expected to pay of your medical bills). Crunch those numbers carefully, and don’t forget about deductibles, copayments, the coinsurance rate and any other costs associated with the plan.
It’s important to know that you can trust the insurance company that’s standing behind you. You also need to know that your insurer will cover the medication and treatments you need when you need them. This might seem odd, but some companies are much better at paying their bills than others. Before you enroll in any health insurance plan, do a bit of digging to find out what others have to say about the company offering it. Customer service, how well they handle claims, how they handle appeals and their overall reputation do matter, sometimes even more than the cost of the coverage itself. If you have a less expensive plan but the company consistently denies claims, then you’re with the wrong company. A more moderately priced plan from a company known for good customer service could make all the difference in your healthcare.
Every major medical plan covers 10 essential health benefits thanks to the Affordable Care Act. But beyond these benefits, individual health plans can choose to cover a host of other treatments and services. If you’re interested in complementary or alternative medicine, look for health plans that cover them. The median price for a visit to an acupuncturist, for example, is around $120. Acupuncture might help with a variety of medical conditions, and you might prefer it to traditional medicine. For alternative treatments and other nonessential benefits, look for plans with broader coverage to save on out-of-pocket costs for these services.
The beauty of health insurance is that it’s not one-size-fits-all, but that can also mean a headache when it comes to finding a plan. During open enrollment, which runs until December 15 in most states, you have a chance to sift through the options and find the coverage that works best for you. Take your time, ask questions and choose a policy that strikes the right balance between coverage and cost.