Health insurance is something you have to consider if you’re experiencing a significant change in your life, such as a shift in your job status, marriage, childbirth, or growing out of family coverage. Read on to learn how health insurance works as well as how to get the most suitable and affordable plan for your needs.
What is Health Insurance?
Health insurance covers your medical costs for injuries, illnesses, procedures, prescriptions, preventative health screenings, and more. You can either get coverage through your employer or purchase an individual health insurance plan.
How to Get Health Insurance Coverage?
There are multiple ways of getting health coverage. You can enroll in a family or individual plan, federal government plan, or employer-sponsored plan.
- Employer-Sponsored Plan – This plan is a benefit that employees get from their employers. About 49 percent of Americans have employer-sponsored health insurance coverage.
- Family or Individual Plan – You enroll in this plan by either visiting the federal or state marketplace, which connects you with private insurers, or going through an insurance agent. The marketplace hosts ACA (Affordable Care Act) plans.
- Federal Government Program – Medicare is a federal health insurance plan that specifically caters to individuals who are no less than 65 years old.
There are multiple plans to consider, so you should think about your most important needs, for example, being able to access healthcare outside the network of hospitals and physicians listed in your plan or being able to choose specialists without needing a referral.
Types of Health Insurance Plans
The most common kinds of health plans include:
- EPO (Exclusive Provider Organization): With EPO, your out-of-pocket costs are lower, and you don’t need referrals. However, it’s more restrictive when it comes to selecting providers.
- HMO (Health Maintenance Organization): With HMO, you’ll get integrated care and a primary physician as well as pay lower out-of-pocket costs. However, you’re limited to in-network providers, and you typically need referrals. Additionally, to qualify for coverage, you may have to work or live in the service area.
- PPO (Preferred Provider Organization): You have more leeway when choosing providers, and you can get out-of-network care without a referral. On the downside, your out-of-pocket costs will be higher.
- POS (Point of Service Plan): Offers more flexibility when it comes to choosing a provider, but you’ll need referrals.
If you only need to visit the primary care doctor for only necessary or annual visits, an HMO plan is ideal for you. If you want more control and freedom in choosing care providers and specialists, a PPO or EPO plan may be ideal for you, but it may be more expensive over time.
Other Things to Consider
Your first step should be to consider your family’s healthcare needs. Secondly, consider out-of-pocket expenses, metal categories for ACA plans, HSA (health savings account), FSA (flexible spending account) options, and premiums and annual costs.
- Annual Costs and Premiums – Your premium is the amount you pay for coverage annually, which may be subsidized by the government or your employer.
- Metal Categories – ACA plans come in four metal categories: Bronze (your insurer pays 60 percent, you pay 40 percent), Silver (your insurer pays 70 percent, you pay 30 percent), Gold (your insurer pays 80 percent and you pay 20 percent), and Platinum (you pay minimal point-of-care costs but the highest premiums).
For more information on how to get the best health insurance coverage for you and your family, contact us at Hoffman Brown Company.
