Step-by-Step Guide to Choosing the Best Health Insurance Policy

From routine medical visits to extensive surgeries and invasive procedures, the cost of medical care in the U.S. is expensive. For this reason, every person, regardless of age, needs health insurance. 

But shopping for the right plan can be confusing.

Whether you’re about to choose a plan through your employer, through the Heathcare.gov marketplace, or through a private insurer, there are a lot of questions you’ll need answers to before you can select the right plan.

Here’s our step-by-step guide to choosing the best health insurance policy.

What Are Your Medical Needs?

Everyone has their own medical history and healthcare needs, so there is no one plan that works for everyone. Before you choose a health insurance policy, think about what your medical needs are. 

Aging adults, people with serious medical conditions, and those with chronic illnesses generally require more care than younger, healthier people without any existing medical concerns. It’s important to choose a policy that provides coverage for your specific medical needs.

When reviewing a policy, read through all of the benefits it provides. This includes everything from maternity services and annual gynecological exams to mental health services to prescription drug costs. 

In addition to researching the benefits the policy offers, be sure to research what exclusions apply and what services are not covered. 

What Are the Out of Pocket Costs?

When it comes to the cost of health insurance, there are some key terms you’ll need to know:

  • Premiums
  • Deductibles
  • Copays
  • Coinsurance

Premiums are the total you’ll pay every month in order to maintain your insurance coverage.

A deductible is the amount of money you’ll have to spend out of pocket before your insurance starts paying for your medical care. Higher deductibles usually have lower premium payments, while lower or zero dollar deductibles have higher monthly premiums.

Copays are a fixed amount that you’ll pay for every medical visit, treatment, or procedure. For example, your copay for primary care visits may be $20 or $50, while your copay for specialists may be $50 or $100 per visit. Like deductibles, lower or zero dollar copays often have higher monthly premiums. 

Coinsurance is the percentage that you’ll pay for each service. If your insurance company pays 90% for a medical visit or treatment, you’ll pay the other 10%. If the insurance company pays 80% of your medical bills, you’ll pay the remaining 20%. Should you need a high-priced treatment, such as a heart surgery or an organ transplant, paying even 10% of the cost can result in an exorbitant bill.

If you want added protection to help cover the high costs of critical medical treatments, consider supplementing your health insurance coverage with critical illness insurance. Checkout this article to learn more about critical illness insurance and determine if it makes sense for you.

Do Your Doctors Accept the Plan?

Some health insurance plans, such as health maintenance organizations or HMOs, will only pay for medical care if your physicians and specialists are within their network. Preferred provider organizations, or PPOs, allow you to see physicians outside of their network, though seeing physicians within the network costs less.

 If you are adamant about keeping the physicians that you have already established a relationship with, check to see if they accept your insurance.

Does the Plan Require Referrals?

Many health insurance plans require referrals, meaning that your primary care physician will need to make an official, insurance-approved referral in order for you to see a specialist or have certain diagnostic tests or treatments performed. In most cases, obtaining that referral requires a visit to your PCP.

Obtaining referrals can be time-consuming and cost you more money if you have coinsurance or have a copay with your PCP. Selecting a health insurance plan that doesn’t require referrals puts you in more control and can save time from having to visit your PCP. 

Compare Multiple Plans Before Choosing One  

While some people prefer to buy health insurance directly through an insurance provider, many people select their coverage from the state plans available through the Healthcare.gov marketplace.

Even if you decide not to purchase a plan through the marketplace, it can be beneficial to compare the plans and rates to see what your options are. Comparing the benefits, costs, copays, and deductibles of various plans will give you a good idea of how much coverage you can get for your money.

In Conclusion

The cost of monthly health insurance premiums can be a financial burden for many, but it’s well worth it. Without health insurance, even paying for occasional, routine medical exams can be a financial drain and jeopardize the security of both you and your family. Should you have to pay for an expensive treatment, it could completely wipe your finances out. 

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