How to Choose the Right Health Insurance Plan | The Hoffman Agency

Choosing the right health insurance plan won’t just ensure that you receive the best medical care for your unique needs. It will also keep more of your money right where it belongs: in your bank account.

Before you begin shopping for health insurance, it is best to narrow down what you would like from your plan. There are three key factors to consider while doing this:

  • Deductible. A health insurance plan’s deductible determines the amount of money you will have to pay out of pocket before the insurance provider steps in, to foot the rest of the bill. If you anticipate receiving surgery or other expensive medical treatment, a lower deductible can save you more money. If you do not anticipate needing medical care at all, a higher deductible may be preferable.
  • Network. Insurance providers may only cover medical care you receive from their own pre-approved network of health care professionals and facilities. If you would like to continue visiting your preferred doctors or other health care specialists, make sure you can do so under your next health insurance plan. If your preferred provider is not part of a plan’s network, you may incur additional costs by continuing to see them.
  • Prescriptions. If you are currently on one or more prescriptions, determine how a plan copays or coinsures those medications. The ideal health insurance plan would require you to spend the least amount of money on your necessary prescriptions. This is presuming it doesn’t cost an exorbitant amount of money for other facets of your medical care.

Having identified what your ideal health insurance plan would offer, you are now ready to begin shopping. The first step is deciding where to shop!

Select the Right Marketplace

Are you able to receive health insurance through your employer? Then your employer is almost certainly the best marketplace, as they will pay a significant percentage of your premium for you.

If you don’t work for a company that offers health insurance, then you may choose to shop on the state or federal marketplace. This is simple: Go to healthcare.gov, select “See if I Can Enroll,” and enter your zip code. This will direct you to your state’s health insurance marketplace, or the federal marketplace if your state hasn’t got one.

If you would rather not involve the government, you have other options. You may also purchase a health insurance plan with the aid of a private insurance company or directly from an insurance provider itself.

Select the Right Type of Health Insurance Plan

There are four primary types of health insurance plans: EPO, HMO, POS and PPO. The one you select will have implications for your deductible, as well as the network from which you can receive medical care. Before committing to a plan it is crucial to review its summary of benefits. It is also important to review which hospitals, doctors and clinics it will permit you to visit.

Explaining the relative merits and disadvantages of each type of health insurance plan is outside the scope of this article. The one you should prefer depends heavily upon your personal finances and medical care needs. The following is intended only as a brief summary of each plan.

  • EPO (Exclusive Provider Organization): A heavily managed plan, in which the policyholder may only receive coverage if they visit doctors and health care facilities that are already within the plan’s existing network (barring emergencies).
  • HMO (Health Maintenance Organization): A plan which restricts coverage to doctors and health care facilities that work directly with the HMO itself. Like EPOs, HMOs typically do not cover care received from outside their networks (also barring emergencies).
  • POS (Point of Service): A plan which does not prohibit you from visiting doctors and health care facilities outside of its network. But it does financially incentivize you to stay within it. Visiting a provider outside of a POS’s network requires a referral.
  • PPO (Preferred Provider Organization): Similar to a POS, except you can seek medical care from an out-of-network doctor or health care facility without a referral. Although you will pay extra if a referral is not requested and granted.

Compare Networks, Costs and Benefits

Even a few different health insurance plans can vary widely with respect to their networks, costs and benefits. To begin, consider whether your preferred doctors, health care specialists and facilities all fall within a potential plan’s network. You may simplify this process by asking your doctor which specific plans cover their services. However appealing a plan may seem, it will do you little good if it denies you access to any nearby health care providers. This is of especial consideration if you live in a rural area with relatively fewer doctors and clinics.

A health insurance plan’s costs are comprised of its deductible, copayments and coinsurance. Exactly how much a plan will require you to pay out of pocket depends heavily on the amount of medical care you anticipate needing. If you are in peak health and would likely only need medical care in the event of an emergency, then an inexpensive plan may make the most sense. But if you have a preexisting medical condition, see a doctor often, or are prescribed costly medications, a more expensive plan which encompasses your individual needs may counterintuitively prove more economical.

Finally, weigh potential plans’ benefits against one another. Some excel at providing coverage in the event of an emergency. Others may place higher importance on different facets of health care such as mental health, prescription medications or physical therapy. There are no one-size-fits-all plans on the market!

Contact the Hoffman Agency for Health Insurance Options

The Hoffman Agency deals in health insurance professionally, so you can take it on our authority when we say choosing the best health insurance plan can be difficult. If you live in Iowa and would like an expert’s help selecting the best health insurance for your budget and needs, then we welcome you to contact us today!