Plans vary greatly. But the general rule of thumb is that the less you pay per month, the higher your deductible is. Higher premiums are usually associated with lower deductibles. Generally it is beneficial for those with existing health issues to opt to pay more per month and less out-of-pocket for services. Those in good health often opt for a high deductible option in hopes that they never have to actually pay the deductible but would mostly be covered if something major happened. A prescription plan is another important consideration. If you need to take medications regularly you'll want to choose a plan with a good prescription plan. If you need to insure your entire family, you'll want to look at family deductibles and maximums. Only full-coverage options will satisfy the minimal essential health care insurance required to get around paying the fine.
Major Points to Compare:
Monthly Premium
This is your monthly payment for health insurance. It may be worth asking if you can get discounts for paying in advance or if you set up direct payments from your bank account.
This is your monthly payment for health insurance. It may be worth asking if you can get discounts for paying in advance or if you set up direct payments from your bank account.
Deductible
The amount you are required to pay, not counting preventive care, before the insurance company starts paying out. Low-deductible plans offer deductibles of about $500, whereas high-deductible plans might be as much as $6600.
The amount you are required to pay, not counting preventive care, before the insurance company starts paying out. Low-deductible plans offer deductibles of about $500, whereas high-deductible plans might be as much as $6600.
Maximum Out-of-Pocket
This is the maximum you'll have to pay out-of-pocket. Sometimes this is more than the deductible. It is not uncommon to have a deductible of $1200 and a maximum out-of-pocket limit of $1500. This of course does not count your premiums.
This is the maximum you'll have to pay out-of-pocket. Sometimes this is more than the deductible. It is not uncommon to have a deductible of $1200 and a maximum out-of-pocket limit of $1500. This of course does not count your premiums.
Preventive Care Covered
Most insurance policies now cover preventive-care visits 100 percent. However, some may limit the number of checkups or how often certain procedures such as mammograms are covered.
Most insurance policies now cover preventive-care visits 100 percent. However, some may limit the number of checkups or how often certain procedures such as mammograms are covered.
Prescription Plan
If you need to take maintenance medications you'll want to find an insurance plan with an above-average prescription plan. You should check to see if it covers the medications you are currently taking satisfactorily or if it covers suitable generics.
If you need to take maintenance medications you'll want to find an insurance plan with an above-average prescription plan. You should check to see if it covers the medications you are currently taking satisfactorily or if it covers suitable generics.
In-Network vs. Out-of-Network Coverage
While in-network providers are discounted, you usually pay significantly more for out-of-network health care. This is a good reason to contact your primary doctors to ensure they are preferred providers.
While in-network providers are discounted, you usually pay significantly more for out-of-network health care. This is a good reason to contact your primary doctors to ensure they are preferred providers.
Types of Plans Available
While looking for insurance you many notice a wide variety of plans. Some may provide coverage for a large selection of doctors whereas others may provide increased coverage to preferred providers.
While looking for insurance you many notice a wide variety of plans. Some may provide coverage for a large selection of doctors whereas others may provide increased coverage to preferred providers.
Here are the most common insurance types explained:
Preferred Provider Organization (PPO)
This type of insurance provides better coverage to providers within their network. Usually the insurance company and the provider have agreed in advance to the billing costs for common procedures. Out-of-network providers, or those without an agreement, might not be covered or will cost the patient more out-of-pocket.
This type of insurance provides better coverage to providers within their network. Usually the insurance company and the provider have agreed in advance to the billing costs for common procedures. Out-of-network providers, or those without an agreement, might not be covered or will cost the patient more out-of-pocket.
Health Maintenance Organization (HMO)
With an HMO plan, you have to work with one primary doctor and all additional procedures or testing is routed through them. You have to have a referral from your primary doctor before seeing a specialist unless it is an emergency situation.
With an HMO plan, you have to work with one primary doctor and all additional procedures or testing is routed through them. You have to have a referral from your primary doctor before seeing a specialist unless it is an emergency situation.
Exclusive Provider Organization (EPO)
This type of plan limits the network of doctors and hospitals covered in order to help control costs. Out-of-network doctors and hospitals are not covered at all.
This type of plan limits the network of doctors and hospitals covered in order to help control costs. Out-of-network doctors and hospitals are not covered at all.
Point of Service (POS)
These types of plans are a mixture of HMO and PPO. You would need to use a primary doctor to coordinate your care, but there is more freedom to visit the health care provider of your choosing. If you visit a provider outside of the network, you have to pay the bill and then submit a claim to the insurance company for partial reimbursement.
These types of plans are a mixture of HMO and PPO. You would need to use a primary doctor to coordinate your care, but there is more freedom to visit the health care provider of your choosing. If you visit a provider outside of the network, you have to pay the bill and then submit a claim to the insurance company for partial reimbursement.
High-Deductible Health Plan (HDHP)
These types of plans usually have lower monthly premiums but higher deductibles. In many cases the deductible is $6,600.
These types of plans usually have lower monthly premiums but higher deductibles. In many cases the deductible is $6,600.
Flexible Spending & Health Savings Accounts
These are not insurance plans, but ways of assisting with medical costs with pre-tax money. Often these accompany a high-deductible plan in order to help cover the high deductible easier. Flexible spending accounts are often use-it-or-lose-it, but health savings accounts typically can roll over to the next year.
These are not insurance plans, but ways of assisting with medical costs with pre-tax money. Often these accompany a high-deductible plan in order to help cover the high deductible easier. Flexible spending accounts are often use-it-or-lose-it, but health savings accounts typically can roll over to the next year.
Short-Term Medical
Short-term medical plans are designed to fill the gap between insurance coverage. So if you are going to be changing jobs, for example, and might have a gap before your new insurance takes over, short-term might help you.
Short-term medical plans are designed to fill the gap between insurance coverage. So if you are going to be changing jobs, for example, and might have a gap before your new insurance takes over, short-term might help you.
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