Has shopping for health insurance left you confused and frustrated? Don’t worry, we’ve got you. Shopping for health insurance can feel about as easy as getting home during rush hour traffic, but understanding your options and how to choose plans is important. To help we’ve put together a list of questions for you to ask while choosing a plan. These questions can help you sift through the various plan details and help you decide which ones are best for you, your family, your health, and your budget. Think of it as your health insurance cheat sheet.
With these questions in your pocket, you’ll be able to confidently compare health plans. Whether you’re selecting a plan for the first time, or if you’re thinking about changing your current plan, these questions are important to keep in mind.
How Much Does the Plan Cost?
You’ll want to carefully look over plan prices, not just the premium, you’ll want to know how much the other out-of-pocket costs will be as well. Premiums, deductibles, copays and other costs of health insurance all vary from plan to plan and state to state. So, comparing is key here to make sure you get a plan that fits within your budget. We’ve gone into a little more detail about each of the costs you’ll want to research below.
Your Premium
This is the monthly fee you pay for your insurance company to provide you and your family with coverage. The cost of your premium will vary depending on a few factors. First, the majority of insurance companies will underwrite you before they insure you. Meaning they will collect all of your health data and use them to determine your “risk factor”. Other variables include your age, your lifestyle, and sometimes even where you live.
Your Deductible
Before your plan will cover your medical expenses, you have to first meet your deductible. For example, say your plan carries a $1,500 deductible and you need a surgery that costs $3,500. You will have to pay $1,500 and then your company should cover the remaining $2,000. Keep in mind, your premium will not count towards your deductible. The things that will count towards it are any bills you pay for hospital stays, surgeries, lab tests, anesthesia, doctor visits that aren’t covered with a copay, and medical devices such as pacemakers.
Your Copay or Coinsurance
When you visit the doctor or fill a prescription, you’ll pay a copay upfront. It’s a flat fee, typically between $10-$30. Each part of your health services may have different copays such as $30 per doctor visit or $20 per prescription, but each of those services will always have that same copay. For instance, if you injure your back and visit the doctor, or if your child’s asthma medication needs to be refilled, the copay amount – for that visit or medication will remain the same.
Coinsurance is the portion of medical expenses you are responsible for after your deductible has been met. Coinsurance is a way of saying that you and your insurance company each pay a portion of the eligible costs that total 100%. For instance, if your coinsurance is 20%, you are responsible for 20% of the cost of your covered medical expenses. Your health insurance will cover the remaining 80 percent.
What Kind Of Coverage Do I Need?
After deciding your budget, the next question is about coverage. Do you have health conditions? Do you know you see the doctor often? Are you healthy? There’s a large variety of plans that will give you more coverage if you aren’t healthy, or less coverage if you are healthy. That way you don’t pay for coverage you don’t need, and you know the things you do need will be taken care of.
Health Maintenance Organizations (HMOs) provide access to doctors within their network, whereas Preferred Provider Organizations (PPOs) provide access to a larger network at a higher cost. There are also 4 plan tiers available: Bronze, Silver, Gold, and Platinum. Each tier has varying prices with varying coverage. If you want a low monthly premium and are healthy, a Bronze or Silver plan is your best option. While Gold and Platinum plans have higher premiums but lower deductibles. Making them ideal for anyone with medical conditions that need more care.
Is My Current Doctor In The Plan’s Network?
One of the most common concerns while searching for health insurance is whether or not you can keep seeing the doctors you already have. If you have ongoing medical conditions, or simply just like your current doctor, the last thing you want to have to do is switch doctors. It means having to explain your entire medical history and probably retake tests you’ve already had done. It can also bring up an issue if your new doctor doesn’t agree with your old doctor’s diagnosis or treatments. Your doctor is definitely one of those situations where familiarity is important. When you’re shopping for health insurance, find out what the plan’s network looks like. The network isn’t just primary doctors either, it’s also hospitals, facilities, and specialists as well. You don’t want to find out too late that the hospital closest to you doesn’t accept your insurance.
Are There Extra Benefits or Perks?
This may seem small, but it can be the selling point between one plan over another. Some plans will offer things like dental and vision discounts, telehealth, gym memberships, etc. You’ll want to decide if you want the bells and whistles or if you don’t really care for them. These perks can be offered as “free”, but keep in mind the more benefits a plan has the more expensive your plan is likely to be.
Will My Plan Travel with Me?
If you travel frequently, whether for work or leisure, you should make sure your plan has the freedom and flexibility you’ll need, regardless of where you are when you need it. You’ll want to look at the network again, and the budget. Will you pay more for out-of-network facilities and doctors? If you do pay more, can you be reimbursed? If it’s Christmas and you’re four states away visiting family and you need the emergency room the last thing you want to do is worry about a giant medical bill.
Is My Medication Covered?
Two-thirds of adults in the U.S. use prescription medications, so there’s a good chance you will too, if you don’t already. It’s not uncommon for you to get caught up in the other details of your health plan and forget to look at the prescription drug coverage. These costs can rack up quickly, so be sure to look at the plan’s drug formulary before you enroll. The formulary is a list of prescription drugs that are covered as well as their associated costs. That way you can better budget for any medications you currently take, as well as any antibiotics you might need in the future.
Will This Plan Cover Alternative Therapies?
If you’re interested in alternative therapies (alternative medicine) you’ll want to make sure those will be covered as well. Some alternative medicine would be a chiropractor, having a home birth, or getting acupuncture. Different health plans handle these types of services differently. In some circumstances they can be covered similarly to your other health care. On the other hand, some plans might have minimal or no coverage for alternative therapies. If this type of care is important to you, make sure to look closely at the plan’s benefits in detail.
Who Can I Call With Questions?
Most people agree that, when it comes to health insurance companies, the worst part is the lengthy phone calls. There is typically a customer service line, but you’ll most likely deal with a lot of transfers or possibly be placed on hold for long periods of time. Some have direct numbers for agents to speak to you directly or chat services where you can virtually ask your questions. Most will even have a discussion forum where you can find the answers to some of your questions. The worst systems are the automated phone systems, where you have to listen to several menus and hope what you need is on the list. There’s a way to avoid all of that hassle and uncertainty though: giving one of EZs agents a call.
EZ.Insure provides highly trained agents in your region who can answer all of the above questions and then some. You get to speak with a real person, -skip the automated line, and get all of -the information quickly. The best part? It’s free! We will assign you to your own personal agent who will search and compare all available plans in your area at no – cost. We make sure to find you plans that fit within your budget without sacrificing coverage needs. To get your instant free quotes today simply enter your zip code in the box below or give us a call at 877-670-3557 to speak to an agent directly.
When it comes to health insurance, most people don’t even think about getting it until they need it. This is because most people are fixated on how expensive health insurance can be. Choosing to wait until you need it rather than getting it while you’re healthy and being prepared can have some serious consequences. What if you get into an accident and don’t have health insurance? If you need surgeries or medical care then you’re stuck footing a pretty massive bill entirely out of pocket. Large medical bills can even bankrupt you! This is just one of many reasons you need to get health insurance sooner rather than later. Below we’re going to look at all the benefits of being prepared for unexpected medical emergencies with health insurance.
Free Services
Let’s start simple, health insurance doesn’t just help you pay for medical bills. It also comes with free benefits built into your plan that help keep you healthy and can help prevent some of those medical emergencies. Typically, your health insurance plan will offer free services such as:
Annual physical exams
Routine blood work
Cancer screenings
Blood glucose tests
Vaccines
Blood pressure monitoring
Blood cholesterol monitoring
These services might seem unnecessary when you’re healthy, but if you’d like to stay that way they’re important. These free services help catch diseases and medical conditions before they’re critical (or fatal). The earlier you catch health complications the easier it is to get treated and back to normal. If you hold off on health insurance you could end up sick without care and unnecessarily have to suffer through symptoms when a quick trip to the doctor could have either prevented it or given you symptom relief immediately.
Health Insurance Saves You Money
Health insurance doesn’t just protect your health but it also actually protects your bank account. We know what you’re thinking, “How would it save me money when I’m paying so much money for a premium?”. By having an insurance plan you’ll actually have less out-of-pocket healthcare costs, since your plan will cover significant portions of your medical costs. Not to mention, staying healthy keeps your healthcare cheaper. Consider for a moment how much you would have to pay out of pocket for an unexpected medical emergency. Medical bills can easily cost hundreds to thousands of dollars.
Take a broken arm for example, a simple fracture that doesn’t need surgery can cost about $2,500 without insurance,but with surgery that fracture goes up to around $16,000. That’s a lot of money for just one medical emergency. Not to mention health insurance itself is actually cheaper to buy when you’re healthy because you’re not as much of a risk to insure.
Staying On Top Of Medical Conditions
Unfortunately, many Americans suffer from a disease like diabetes, hypertension, high cholesterol, COPD, or even cancer. Even the healthiest person can suddenly develop a disease, especially if it’s hereditary. You need healthcare in order to control or prevent them from getting worse. Some diseases if left untreated can also start to cause you to develop other illnesses or compromise your immune system, making it harder for you to fight off even the slightest illness like the common cold. Without health insurance, prescriptions, treatments, doctor visits, and hospital stays that are linked to a medical condition can cost tens of thousands of dollars. Your health insurance makes sure that you don’t go broke while trying to care for these health problems.
In addition, the Affordable Care Act requires Marketplace plans to cover pre-existing conditions. This means that even if you already have a diagnosis, you can’t be denied coverage or charged extra just because you have a condition. Since you’ll have access to all the care you need, your health insurance plan helps manage your care for any chronic illnesses you have.
Family Planning
If you plan to start a family, even if it’s not anytime soon, health insurance is a must. Having health insurance before starting a family gives you access to maternity appointments, vaccinations and hospitalizations you’ll need throughout yours or your spouse’s pregnancy. Medical costs linked to pregnancy can easily reach $10,000 and higher. Not to mention, it’s so much easier to simply add your newborn to your existing health plan. Your new baby will immediately have health insurance and you’ll never have to worry about pediatrician bills. Plus as children age they tend to need a lot of healthcare, they can get hurt or sick easily while their immune systems develop, especially once they hit school age. Trust us, flu season is no joke for kindergarteners, you don’t want to be caught without health insurance when it hits.
Protects You Between Jobs
If you get health insurance through your employer, then unexpectedly losing or having to leave your job can be difficult. When you stop working there, you lose all those health benefits as well. Nonetheless, it doesn’t have to be hard. If you lose your job you may actually qualify for a Special Enrollment Period, so you won’t have to wait for the annual Open Enrollment Period to enroll. This ensures you don’t have to go months without coverage.
Another option for small gaps in coverage are short-term health plans. Instead of enrolling in a year-long plan, short-term health plans give you access to health insurance for a few months to make sure you’re always covered, even if you only need it for a little while. They are inexpensive and provide all the essential health benefits during the policy. However, it’s important to note every state handles short term health plans differently. State’s have their own guidelines about how long you can have a short term health plan, and some state’s don’t even allow them to be sold. To learn more about how short term health plans work in your state check out our state by state health insurance guides here
Which Plan Is Best For You?
Let’s take a look at your options for health insurance plans. There are so many options you’re sure to find one that works for you and within your budget. With health insurance there are two main decisions you need to make, which plan type and which metal tier you want.
Plan Types
HMOs, PPOs, EPOs, and POS plans are your main types of health insurance. Don’t worry we’ll explain the alphabet soup below. The type of plan you select will determine what your out-of-pocket costs are as well as what your provider options are.
This type of health plan typically restricts your coverage to care from their in-network providers. It will only cover out-of-network care during an emergency. They also usually require you to live within their service area. Don’t worry too much about the service area, there’s plenty of companies to go around, no matter where you live you’ll find a plan. With an HMO you select a primary care provider (PCP) who will coordinate all of your care and provide referrals to specialists when you need them.
Just like HMOs, PPOs have a group of contracted doctors and providers that make up their network. However, with PPOs you do also get some coverage for out-of-network care as well. Although, seeing in-network providers saves you more money since your plan will cover more of these services. PPOs don’t require you to choose a PCP the way HMOs do and you don’t need referrals to see specialists. So, you’ll be in charge of coordinating all of your own care with this plan.
Exclusive Provider Organizations (EPOs)
EPOs also provide you with access to a network of participating providers, with the exception of emergency situations, the majority of EPO plans do not cover out-of-network care. You may or may not be required to choose a PCP, based on your plan. In either case, you do not need a referral from your PCP to see a specialist within the plan’s network.
Point-Of-Service (POS)
POS plans combine PPO and HMO characteristics. Similar to an HMO, the provider network for a POS plan is typically smaller than that of a PPO plan, and similar to a PPO plan, in-network care expenses are typically less expensive. In POS plans, you must choose a primary care physician (PCP) from the network of physicians and other primary care specialists. If you have a POS, you must obtain a referral to see a specialist. However, similar to PPO plans, you have the option of seeing either in-network or out-of-network specialists. However, if you visit an out-of-network provider, your portion of the costs will be higher, and you will be responsible for submitting claims.
Metal Tiers
Since The Affordable Care Act went into effect in 2010, traditional health insurance plans are generally purchased through the Marketplace. When you buy a plan through the Marketplace they are separated into 4 categories: Bronze, Silver, Gold, and Platinum. The plans in these tiers are categorized based on their price and how much of your health care you are responsible for vs. how much your health plan pays for.
Bronze
Bronze plans have the cheapest monthly premiums but the highest deductibles and out-of-pocket costs. With a Bronze plan your insurer covers 60% of your medical expenses and you’re responsible for the remaining 40%. Bronze plans are a good option if you don’t use medical services frequently but need a low-cost plan to protect yourself against severe illness and injury. Since the deductible and cost-sharing percentage are both relatively high, you’ll be responsible for the majority of your care.
Silver
Plans at the Silver tier have moderate monthly premiums and out-of-pocket costs. These plans cover 70% of your medical expenses, while you are responsible for the remaining 30%. These plans are an excellent option for those who are willing to pay a bit more to have more of their routine care covered.
Gold
Although Gold plans have high premiums, the out-of-pocket cost of care is lower than that of higher-tier plans. These plans have low deductibles, and your plan will cover 80% of your care while you pay 20%. If you require extensive medical care, a Gold plan may be a suitable option, as it will cover more of your expenses.
Platinum
The Platinum tier has the highest monthly premiums of all the tiers. However, despite the high premiums, your out-of-pocket expenses will be the lowest of any plan type, and your insurer will pay more of your expenses throughout the year due to the extremely low deductibles. Due to the fact that these plans cover 90% of your medical expenses, they can be a good deal for those in need of numerous medical services.
Get Insured Today With EZ
Although health insurance may appear expensive, it is important to evaluate a plan’s value and how much you will save over time. When comparing the overall cost of health insurance versus the cost of a medical emergency without coverage, it pays to have protection. In the event of a medical emergency, the last thing you want to worry about is finances. Knowing that your loved ones are protected and can seek care, rather than attempting to “ride it out” due to lack of insurance, is priceless. Speaking of priceless, EZ.Insure can help you compare every plan available to you and make sure you stay within your budget, and we do it all for free! To start, simply enter your zip code into the bar below to get your free instant quotes or give one of our licensed agents a call at 877-670-3557.
