MEDICAL SPOTLIGHT: What to Consider When Choosing a Health Insurance Plan
By Space Coast Daily // June 15, 2018
After the passing of the Affordable Care Act, the number of people without health insurance steadily declined. However, now, that number has begun to rise again. At the end of 2017, 12.2 percent of all adults in the United States lacked health insurance. This is up from 10.9 percent at the end of 2016.
If you don’t have insurance, or just want to find better insurance, then you may wonder what to do first. After all, not having this coverage can be quite expensive.
While finding the best health insurance companies is an important priority, you also have to consider several other factors. Not all health insurance plans are created equal and to ensure you get the one that best suits your needs, you should consider the factors listed here.
The Out of Pocket Costs
The out of pocket costs you are expected to cover when purchasing health insurance include the copayments and deductibles. In most cases, these are expected at the time you receive a health-related service (i.e. doctor’s appointment, prescription medication, etc.).
The ACA limits the out-of-pocket costs for the majority of health plans, regardless of funding type or size – including the plans sold through a public insurance market. The only health insurance plans not required to stick to these limitations are those that are defined as grandfathered plans.
Co-payments are fees you pay to health care providers when a service is rendered. Deductibles are a type of co-insurance, which means you are responsible for paying a portion of the cost of the insurance.
Essential Health Benefits
According to the ACA, the essential health benefits are a set of health care service categories that every health plan has to cover in both the small group and individual markets.
The items included in the list of essential health benefits are any services or items that fall in one of the following categories:
- Vision and oral care
- Pediatric services
- Chronic disease management
- Preventive and wellness services
- Laboratory services
- Rehabilitative and habilitative services and devices
- Prescription drugs
- Behavioral health treatment
- Substance use and mental health disorders
- Newborn and maternity care
- Emergency services
- Ambulatory patient services
It’s important to find a plan that covers services in all of the above-mentioned categories to ensure you are covered, regardless of the health issue you are facing.
Consider the Type of Health Insurance Plan
When shopping for health insurance, you have choices. If you choose to work with your state’s Marketplace, or if you work with an insurance broker, you will choose from health plans that are organized by the level of benefits offered – bronze, silver, gold and platinum.
The bronze plans offer the least amount of coverage and lowest prices, while the platinum plans have the most coverage and highest costs. Each of the plan’s details vary including deductibles, co-pays, etc. There are also several brands offering insurance coverage to choose from.
Each of the insurance brands offers one or more of the four most common types of plans:
- Health maintenance organizations (HMOs)
- Point-of-service (POS) plans
- Preferred provider organizations (PPOs)
- High deductible health plans (HDHPs)
- Exclusive provider organizations (EPOs)
It’s wise to get to know what each of these plans offer. By being familiar with the plans, you can choose one that fits your budget and that meets your healthcare needs.
In some cases, working with a broker will be beneficial, as they can help steer you in the right direction regarding a plan that not only meets your needs, but that is also within your budget. Finding the right plan can seem challenging, but when you use the tips and information here, you will be on your way to finding the one that best suits your needs.
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