When considering health insurance plans, residents should spend time researching and carefully considering their options.
Prospective beneficiaries should familiarize themselves with the different plans available to them before finalizing their selection.
Residents should read about the various coverage levels associated with each plan to determine which one best suits their and their family’s needs.
Furthermore, understanding medical needs and priorities will also be helpful in determining the right plan.
Continue reading to learn about important information that can help you decide on the right health insurance plan.
Learn About Health Coverage Options
Residents seeking to purchase health insurance should focus on learning about the different types of plans available prior to purchasing one.
Although, unique household needs will determine which plans best address issues, knowing the various options help to narrow down the choices.
The following are the most common types of health plans that residents will find in their state health insurance marketplace:
- Health Maintenance Organizations (HMOs) – A network of facilities and medical care providers that have an established relationship with the health insurance company. Beneficiaries are required to obtain a referral in order to visit a specialist under this plan.
- Preferred Provider Organizations (PPOs) – Give more freedom to members in choosing their doctors. Enables beneficiaries to visit specialists without a referral from a primary care physician. Out-of-network care is partially covered under these plans. However, PPOs are associated with higher costs than HMOs.
- Exclusive Provider Organizations (EPOs) – Give enrollees freedom to choose their physicians and visit specialists with referrals but do not provide out-of-network coverage for non-emergency situations.
- Point-of-Service Plans (POS) – Allow enrollees to choose their care facilities and physicians at lower costs than other types of plans. However, members do need referrals to visit specialists and submit additional paperwork for out-of-network visits.
- High-Deductible Health Plans with or without a Health Savings Account (HDHPs/HSA) – Ideal for low-risk enrollees who do not have serious illnesses. Similar to HMO plans with lower premiums. Can be combined with an HSA to pay for high deductibles associated with these accounts.
- Fee for Service (FFS) plans – Allow enrollees freedom to choose any physician and care facility without limitation. However, these are less common than other types of health plans and are expensive.
Learn About Health Insurance Marketplace Coverage Levels
Health care plans found through state marketplaces can be purchased at different levels of coverage.
At different coverage levels, members will pay a certain percentage of medical costs while the insurer providers the rest.
The levels are divided based on the amount the insurer will cover.
Moreover, health plans like family insurance and catastrophic health insurance will have very different levels of coverage and can only be purchased by certain eligible residents.
Understanding the levels of coverage can increase the chances of selecting the best health insurance plan.
Below are the different coverage options that prospective recipients can choose from:
- Catastrophic – Pays for a beneficiary’s first three primary care and other preventative care visits. In general, provides less than 60 percent coverage. Usually offered to members who are 30 years of age and younger.
- Bronze – Insurer pays approximately 60 percent of medical costs while policy holder pays 40 percent.
- Silver – Insurer pays approximately 70 percent of medical costs while policy holder pays 30 percent.
- Gold – Insurer pays approximately 80 percent of medical costs while policy holder pays 20 percent.
- Platinum – Insurer pays approximately 90 percent of medical costs while policy holder pays 10 percent.<
- Family – Covers all qualifying members in a single household. However, percent of coverage varies greatly depending on a number of factors including provider network, amount of family members in plan, services coverage and more.
How to Consider Needs and Cost
After becoming familiar with the different types of health insurance plans and coverage options, residents should then think about their medical priorities and needs and how they can get their needs met at an affordable cost.
Different plans are able to cover different medical priorities.
Thus, deciding on medical and health priorities can help residents choose an insurance plan that addresses prospective enrollees’ issues.
There are several common considerations that residents make when researching health care plans. One common concern is low upfront costs.
HMOs at the bronze coverage level and catastrophic health insurance are most capable of meeting this need.
These plans are best for low-risk groups who do not expect to have major medical needs in the near future.
While enrollees will be paying lower premiums, they may wind up paying much more if they experience a medical emergency.
Moreover, healthy adults who are younger than 30 years of age can also benefit from a catastrophic health insurance plan.
These plans typically have very low costs and can provide the right amount of coverage for residents without significant health needs.
In addition, many residents seek low copays or deductibles. POS and FFS plans are not ideal for members who want this.
Residents should seek out plans at the platinum coverage level instead. Furthermore, other prospective recipients seek out plans that are able to provide coverage for the whole family.
These members should purchase a family health care plan which provides comprehensive coverage for all eligible household members.
Conversely, some residents seek the freedom to choose their own medical providers. FFS plans offer the greatest amount of freedom.
However, prospective members can also opt for a PPO, POS or HDSP plan to receive partial coverage for out-of-network providers at lower costs.
Another top concern among residents researching health insurance is a low amount of paperwork. Plans with a set network of providers (in-network providers) will have the least amount of paperwork for members to complete.
HMO and EPO plans are ideal for this purpose. Policyholders will not be required to submit claim forms as they would with out-of-network providers.