Here are the top steps to take to ensure that you get the plan that suits both your budget and health care needs:
1. Learning the language of health insurance
Just about every health insurance policy comprises a few basic components. In order to make an informed decision, you need to make sure you know the definitions of these terms:
A monthly payment you make to the insurance company in exchange for medical coverage. Ex) If under group health insurance coverage, the premium is paid in whole or partially by the employer on behalf of the employee or the employee’s dependants.
A fixed fee paid by the policyholder for office visits, emergency room visits and prescriptions due at the time of service. Ex) Your health insurance plan requires a $15 co-pay for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges. Instantly browse different plan options and health insurance quotes, to learn more.
An amount of money that you are required to spend on your own medical expenses before the insurer coverage begins. Note, monthly premiums and co-pays typically don’t count towards your deductible. Ex) Choosing a plan with a higher deductible can keep your monthly premiums lower.
A percentage of medical expenses for which the insured is responsible up to his or her out-of-pocket maximum. Ex) If your insurance benefits cover 80% of x-ray charges, you would need to pay the remaining 20% (co-insurance), even if your yearly deductible has already been met.
AKA a stop-loss limit, this is the maximum amount of money the insured will pay before the insurance company begins paying 100% of expenses. Ex) If annual OOPM is met through payment of deductibles, co-pays, and co-insurance, the insurance carrier will pay the remaining costs for that year.
This is the maximum amount an insurance company will spend on a patient in his or her lifetime. Ex) This term might be in the fine print of the plan you’re considering, but make sure the plan’s lifetime max is at least 2 million dollars.
Health Saving Accounts
To take more control over your own medical spending, you can set up a Health Savings Account (HSA) in which you can invest pretax income. As long as you use the money for health care expenses it will not be taxed. These accounts are accompanied by high-deductible health insurance plans, which ensure that you are covered for medical expenses that exceed the money in your account.Ex)
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2. Evaluate your situation
Knowing your priorities will help you narrow down your choices and weigh the pros and cons of each plan. Here are some questions you should answer before you begin shopping for a policy:
What monthly premium can I afford?
Do I want coverage for preventive care or just in case of a major illness or accident?
Who has the largest or most convenient provider network for my lifestyle?
Do I want greater control over my medical resources?
3. Take advantage of free expert advice
There are literally hundreds if not thousands of health plans from which to choose. When you have assessed your needs, you can benefit from the help of a health care exchange, either through online tools or a telephone conversation. A health care exchange can quickly filter your information and present you with a few alternatives that match your personal requirements. Services such as Getinsured.com specialize in individual insurance and are staffed by experts. They will help guide you through the process from selecting an ideal plan to completing your application and receiving your policy. And, because this service is free, there is no reason to not take advantage of this unparalleled opportunity.
4. Honesty is the best policy
Some people are afraid that if they tell the truth on a health insurance application they will be rejected. Yes, given the current laws, there is a chance that if you have a pre-existing condition you may be turned away. However, if you lie about such a condition, the insurance company will certainly find out can legally cancel your policy. It is in your interest to be honest. Even if you have a pre-existing condition you might be eligible for some amount of catastrophic coverage. Talk honestly and confidentially with a health insurance agent-you may be surprised by what you learn.
5. Buy health insurance separately when needed
Just because one member of a family has a pre-existing condition, doesn’t mean that the whole family can’t be covered. The family can be covered by separate plans. For those who are not ill, purchase an affordable, comprehensive plan. The person who is more difficult to cover still has options. If you can afford it, there are guaranteed issue plans. Others may choose to be covered in the case of an accident. And still others may choose to participate in non-insurance discount programs. Of course, combinations of these approaches are possible too-check out our explanation of the basics of family health insurance for more information.
6. Only consider plans that cover your preferred doctor and hospitals
Even if a plan boasts an enormous provider network, take the time to check that your favorite doctor is included. If not, you may find out too late and be forced to make the choice between paying substantial out-of-network fees and choosing a new doctor. The same is true of hospitals. Make sure that the hospitals that are included in a prospective plan’s network are not only reputed to be high quality, but also conveniently located.
7. Make a side by side comparison
Once you have narrowed down your choices, line up the final contenders and write down the premiums, in-network deductible, co-pays for office visits, AM Best ratings (a measure of the underwriter’s ability to pay claims), co-insurance and any other attributes that are important to you.
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