How to Compare HealthCare Plans: A Guide to Helping You Choose the Best Healthcare Coverage For You and Your Family
Looking for the right healthcare plan, and not sure where to start? You’re not alone! Whether you’re a potential policyholder or looking to change an existing healthcare plan, the numbers and terminology can feel overwhelming.
At Healthy Halo, happy, healthy, in-the-know customers are our goal - and we’re pleased for the opportunity to run you through this health insurance crash course, giving you all the tools you need to compare plans, get the best possible care for you and your family AND to help you save!
Comparing plans to find the best health insurance for your specific situation doesn’t have to be confusing or burdensome. Knowing key terms, having a specific idea of how you and your family’s healthcare story will change over the next year and having a price range in mind will help you get there.
In our this easy-to-follow guide, even those new to healthcare insurance terminology will learn the basics of:
- The different healthcare plans available;
- Where to purchase a policy;
- The best process for choosing from a list of competitive plans;
- What the numbers mean: deductibles, copayments, coinsurance and out-of-pocket costs;
- How to use the previous year’s healthcare cost calculations and anticipated annual costs to make smart healthcare decisions for your whole family.
It’s important to us to help you navigate your options so we can get you insured. During their 2018 data run on national health insurance statistics, the CDC determined 30.1 million people under 65 in the United States are uninsured. There are options available, even for our customers who don’t think health coverage is in their budget or their means.
The easiest way to look at shopping for insurance and comparing coverage is to think about it as a process of elimination. You know what you and your family need - so immediately reducing those plans that don’t fit the bill for you, either in your budget or in the details, is as easy as going one by one through your most important criteria.
Let’s go through reading some of the fine print so you can compare options and find the best health plan for you.
What type of health insurance coverage do you need?
For starters, everyone shopping for health insurance needs something a little different. For example:
- A family with young children;
- Two single, healthy married adults;
- A single person with a chronic illness
… all have very different healthcare issues and requirements.
You know your own situation better than anyone, so start by taking a look at your nuclear family’s healthcare needs. Think about doctor visits and your healthcare over the past year, and use that as your baseline. You can always adjust your health insurance needs from year to year, but for starters:
- How many times did your family members visit a doctor in the past year?
- Are major health changes coming up that would require hospitalization or surgery?
- Does anyone in your family suffer from a chronic illness?
- What about major life changes, such as a pregnancy, or an age change that would require increased preventive care?
- What is the general level of health for you and your family members? Any health issues may make your plan more expensive.
Next, consider your current health care situation:
- Do you have a primary care physician?
- If so, how important is it to you to stay in this physician’s care?
- Do you rely on prescription medications? If so, what are they? Is a generic brand available?
Where to buy affordable healthcare insurance
While most Americans (~70%) get some kind of coverage from their employer or a private health care plan, there are plans out there for those who don’t have that option. If your employer offers healthcare plans as part of your employment contract, this is perhaps one of the most inexpensive ways to get insurance. Health insurance employer pools can provide cost savings in a few ways, with group discount options or when your employer pays for part of your coverage. The rest typically comes out of your paycheck, and you may not even feel the weight of that expense from month to month.
If your employer doesn’t cover you, you have two options: shop in the metal marketplace, which you’ll either find optioned through your state or through healthcare.gov during an open enrollment period, or shop with private insurers or the carriers themselves. In our case, we match our customers with the best possible carrier solution based on their specific situation, so we can give you a wide variety of options that include quotes from all the carriers we work with.
While employer health coverage plans may vary, you’ll still be given options to choose from based on your employer’s preferred carrier(s). You’re free to change these options during a major life event (marriage, divorce leaving you without coverage, etc.) or during your company’s enrollment period. You will also be able to apply for healthcare through COBRA if you lose your job, or apply medicaid if you become financially eligible outside the enrollment period.
National open enrollment for metal plans often runs November through December, so if you want to look at plans outside your employer’s options, you can select a plan independently at the end of each year.
If your employer provides your insurance and you have questions, your workplace HR should be able to assist you with answers to all your questions about your individual policy.
What is covered in your health insurance plan?
Budget is important to everyone! Even with the money to spend, families don’t want to pay top dollar for insurance unless they’re absolutely sure it will be worth it and will provide the needed care. So aside from budget, it’s important to think about:
Whether or not you want to see the same doctor;
Whether it’s important that you may need a referral to see a specialist
The answers to these questions will determine what type of insurance you need.
Here are the different types of plans you’ll see with your insurance agencies:
HMO (Health Maintenance Organization):
- You MUST see an in-network provider - meaning, a provider that your carrier covers UNLESS you have a medical emergency (e.g., visit an ER). So if you’d like to stick with your current doctor, you’ll need to make sure they’re in the carrier search database before you sign up for the plan.
- You will need to get a referral from your doctor before seeing a specialist. So if you, for example, need to see an allergy specialist or an ear nose and throat doctor, you’ll need for your general practitioner to give you a referral before you make an appointment your insurance will pay for.
- HMO plans typically carry less out-of-pocket expenses throughout the year.
PPO (Preferred Provider Organization):
- You can select out-of-network providers to work with, and your insurance plan will still cover your care at a higher cost;
- You don’t need a referral to see a specialist
- The downside is there are often higher out-of-pocket costs associated with PPOs.
EPO (Exclusive Provider Organization):
- You are required to see an in-network provider, unless you’re having a medical emergency
- You do not need a referral to see a specialist
- EPO plans give you a pool of local providers you can choose from.
POS (Point of Service Plan):
- You don’t need to see an in-network doctor, though out-of-network providers will be more expensive to visit;
- You DO need a referral to see a specialist
Making the comparison
If you truly want to stick with a primary care physician you’ve been seeing, narrowing down your choices is a bit easier. In this case, you’ll either need to go with a PPO or POS, OR you’ll need to only work with HMO or EPO plans under which your provider can offer care.
To make this easy, when you begin your healthcare search, any HMO or EPO plan carriers offer databases that can be easily searched to see if your current doctor works with them - or, you can always call your physician to get an idea of what insurance companies they work with.
If you’re less picky about your doctor, then you can move on to your next set of criteria: making sure your basic needs are covered.
Tailoring your health insurance plan to your needs
This is where things get granular. Do you have specific medical conditions that require certain drugs or care? What about needing vision or dental? Whether you’re independently shopping through an agency or carrier or you’re looking at metal plans, some plans come with dental and vision and some don’t. You can sift through plans based on your specific needs at this point, getting rid of plans you know don’t fit the bill.
Health premiums, deductibles, copays and more
Now that your basics are covered, it’s time to understand the numbers. It’s important not just to focus on that monthly premium number, but to look at a few other metrics you’ll see as part of your plan:
- Deductible. This is the amount you’ll need to pay before your care will be covered in full by your insurance company.
- Copayments. You may see something on your insurance card that lists out your copay for a visit to a GP or family physician. This is typically between $30-50. This is the amount you’ll pay after you meet your insurance minimum deductible for the year.
- Coinsurance. This amount refers to a percentage of money you’ll pay up to your deductible amount if you need a medical procedure or to go to the doctor. Once you’ve met your deductible, you won’t need to worry about co-pay. Your annual out of pocket maximum, either for yourself or for your family, is listed on your policy and is the maximum amount you will pay for insurance in a calendar year.
Let’s say you require a major unplanned surgery that costs $3000. Your deductible is high - $5300 - so that your monthly payments are a little lower. At 30% coinsurance, you’d need to pay $900 for the procedure as well as whatever copay you’re responsible for.
With a higher deductible, you’ll pay a lower monthly premium. Lower deductibles mean paying a little more out of pocket every month. Here’s where your individual needs kick in - if you think you’ll be using your plan for several doctor visits or major surgery, it makes financial sense to go with the lower deductible plans.
Weigh these decisions based on what you’re looking to pay monthly for you and your family and on your healthcare situation to see what’s best.
Healthcare comparison: A 500-foot view
Looking at all the potential options might feel overwhelming at first, but it’s all about narrowing your choices down to the few that work best for you, your budget and your family’s needs, then picking the most appealing based on what you expect to happen in the year ahead.
Another option is to let us do the work for you! We’re always happy to find potential solutions for our customers, and to let the carriers compete for your business so you can get exactly what you need at rates you can afford.
Standing By To Help You
Our licensed benefits advisors are standing by to help you with any questions you may have.
Call (877) THE-HALO