Your guide to choosing a health insurance plan



Choosing a mutual health insurance is not easy. The terminology can be overwhelming and comparing facts and figures becomes confusing. Nevertheless, it is essential to have insurance in order to protect the well-being and finances of your family.

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Illness or accident can affect your immediate financial future if you don’t have health insurance. The National Consumer Law Center reports that nearly 52% of old bills submitted to collection agencies are related to medical debt, and that medical bills are the number one reason Americans file for bankruptcy.

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But how do you go about buying medical insurance? Read on for some tips.

Determine your insurer

When you are hired for a new job, your employer will tell you about health insurance benefits and you may have several options to choose from. Your employer will likely pay a share of the monthly premium; you will pay the rest with payroll deduction.

If you are a construction worker or work for a small business that is not required by law to offer health insurance, your option is to look to the government-sponsored marketplace to purchase a plan that fits your situation. your family’s budget and needs. Visiting will direct you to your state’s marketplace, if it has one, or purchase plans from the federal site. Depending on your income, you may qualify for a premium tax credit to help pay for your insurance.

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Register for Open Registration

You are allowed to sign up for insurance at specific times of the year only.

For employer-sponsored insurance, your job is your first chance. If you bypass that, your next opportunity comes at Open Enrollment, an annual event that lets you choose a plan at your workplace or change your existing insurance. The market also has open listings, and it usually falls in the fall.

Can you get insurance coverage outside of the open registration period? The answer is yes, if you have experienced what is called a “qualifying life event”. These events include a change in marital status, either being married or divorced; having a baby or adopting a child; losing your job and the insurance coverage that comes with it; the death of the family member who held the insurance; move to a location where your existing insurance is not available; become ineligible for Medicaid and similar plans; and be 26 and lose eligibility through your parent’s insurance.

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Know the acronyms

If you’re a first-time insurance buyer, you’ll be introduced to a variety of unfamiliar acronyms – HMO, EPO, PPO, and POS among them. Each is a type of plan that impacts the cost of your premiums and describes the doctors and hospitals that can treat you. Some of the keys to look for include whether your current primary care physician or any specialist you see participates in the plan, or whether you need a referral before seeing a specialist.

Check the benefits

Your employer and market health plan documents will show you a benefits summary, outlining your financial commitment beyond your monthly premiums.

In this section, you’ll see your annual deductible — the amount you pay before your insurance starts paying for office visits or procedures — as well as your maximum outgoings per year. The summary will also show you how much you’ll pay for things like an emergency room visit, outpatient surgery, or hospitalization, either as a lump sum or as a percentage of the cost. Your benefits for annual visits, prescriptions, lab work, and mental health care will also be listed.

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Watch on-net vs off-net

Physicians and healthcare facilities will be “in-network” or “out-of-network”. Your benefits will be greater if you use a provider that is part of the network, and you will pay more for a visit to a provider outside of it. Before signing up, check if your doctor is in the network. If you don’t have a preferred doctor, still check the choices in the network to make sure doctors and facilities are close to you, which is especially important if you live in a more rural network.

Consider your family’s health

If you are single and in good health, a plan with a higher deductible, which will carry a lower premium, may be suitable for you. But if you have a chronic illness, are planning to have a baby, or have children prone to problems such as asthma attacks and sports injuries, a reduced-deductible plan will cost more but offer greater benefits. throughout the year.

Final Thoughts

Choosing a health insurance plan is not something to be taken lightly as it can have a big impact on your personal finances. While it’s impossible to predict what illnesses or accidents might occur in the coming year, it’s wise to choose a plan that gives you the best coverage for pre-existing conditions as well as any health issues you consider, such as physiotherapy to treat a persistent back problem or prenatal and maternity care. You’ll pay more each month for an upgraded plan, so weigh the potential financial benefits when making your choice.

If you have questions, your company’s human resources department may have the answers, or you can call the insurance plan’s customer service representatives. If you’re shopping in the Marketplace, you can request the free assistance of a Navigator – a person or organization trained to help you navigate the options.

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