Since 2010, almost 20 million Americans have gotten health insurance coverage. The Affordable Care Act (ACA) has made insurance more affordable, but it’s still not cheap.
If you don’t have employer-sponsored health insurance, you have to compare health insurance providers. And finding the best insurance can be overwhelming.
Keep reading to learn what you should consider when looking at health insurance plans.
1. Insurance Premium
The first thing to consider when shopping for health insurance providers in the insurance premium. Premiums can vary based on your location, age, and the number of people in your family.
It will cost less to insure yourself than a family of four. Younger people will also typically pay less than older individuals.
Your smoking history can also factor in your insurance premium. However, since the Affordable Care Act (ACA) was enacted, providers can’t give you a price based on pre-existing conditions or if you currently have coverage.
2. Individual and Family Deductible
While you have to pay your insurance premium every month, you have to consider your annual deductible. If the cost of insurance seems low, it’s probably because you have a high deductible.
That means you have to pay more for your medical cost before your insurance provider starts to pay. You can have an individual deductible, and plans for a family will have a family deductible.
If your individual deductible is $1,000, you have to pay that amount before your insurance starts helping with costs. And if your family deductible is $2,000, your whole family would need to meet that amount.
3. Out of Pocket Maximum
Even if you reach your deductible, you may still need to pay. Health insurance providers usually have a separate amount that represents your out of pocket maximum.
After you reach that, your provider will cover your entire medical bill, as long as you don’t go to providers out of your insurance network.
Sometimes, your out of pocket maximum is around the same as your deductible. But other insurance plans can have a big discrepancy between the numbers.
Once you reach your deductible, you may still need to pay for a portion of your medical costs.
4. Health Savings Account (HSA)
A health savings account (HSA) is a tax-free account you can contribute to for funding your medical expenses. You can put money into the account, and you can deduct that amount from your taxes.
If you have a high-deductible health plan, you can get an HSA through your employer or local bank. The HSA can help you cover the deductible, and you can save for those costs throughout the year.
However, an HSA isn’t for everyone. If you want a more traditional insurance plan, you can still save for expenses, but you won’t qualify for an HSA.
5. Network Providers
All health insurance providers have a network of doctors and hospitals. If you get medical treatment from that network, your insurance plan will cover some or all of the costs.
You can also look at options for providers out of your network, but you will have to pay for the bill. If you can’t afford an expensive procedure, like LASIK, you can look at LASIK financing.
That way, you can go to the doctor you want for your treatment. But you won’t have to wipe out your savings or max your credit card.
Your network will typically include local doctors and facilities. Some plans have a smaller network, and those plans are usually cheaper than plans with larger provider networks.
6. Prescription Drug Coverage
If you or someone on your health plan takes a prescription, this is essential. And even if you don’t take prescriptions, that could change.
When looking at the cost of insurance, consider if your plan covers specific drugs. You should know if the health plan covers brand names or prefers generic drugs.
If you or a family member needs a specialty drug, you should also make sure they cover those. Some plans will cover generics but not more expensive medications.
Lastly, if you use a manufacturer copay card, you should know if your plan uses an accumulator adjustor.
In 2020, the Department of Health & Human Services stopped requiring health insurance providers to accept copay cards as part of your insurance deductible. So if you have a copay card, that could affect how much you have to pay.
7. Medical Use
When looking at health plan networks, you should also consider how much you anticipate using your plan. If you’re healthy and young, you may be able to get by with a cheaper catastrophic plan.
However, if you take one or more prescription drugs or see a specialist, you may want more coverage. It may look more expensive on paper, but you could save money on long-term health costs.
It can be hard to know how much you’ll use your insurance. However, consider how much care you needed last year when deciding on the right plan for next year.
If you can’t decide between two plans, go with the one that offers more coverage. You never know when something might happen, so you want to be safe.
8. Making Claims
You should also consider how hard or easy it is to make an insurance claim. While doctors usually take care of this, it’s important if your provider is out of network.
Your insurance plan may not cover the cost, but it’s worth making the claim for a rebate. So consider if you can create an online account to file the claims.
Figure out if you can file your claims digitally or if you have to mail a paper form. Determine what information you’ll need so that you can have it available whenever you need it.
Not everyone will have to file a claim individually, but you should choose health insurance providers that make it easy. After all, you never know when you might need it.
Choosing Health Insurance Providers
The best health insurance providers offer affordable plans with plenty of benefits. If you’re trying to choose, look at your budget and healthcare needs.
Then, you can consider your options for providers and the overall cost of insurance.
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