Health

What Will Health Insurance Cost You on Average?

Even though you have a short time frame to buy insurance, making the right choice is essential to avoid burdensome costs. Taking the time to find the right service provider ensures more affordable healthcare access.

Choosing the Right Options

Your employment and other circumstances determine which insurance options are available.

If Your Employer Offers Benefits

Employer-sponsored benefits are how most people receive insurance. Your employer’s insurance will likely cost less than insurance purchased from the marketplace.

One thing worth remembering is that employers pay part of the cost of employer-provided insurance. This cost offset isn’t available when buying on the marketplace.

If You Don’t Qualify for Employer-Provided Coverage

If your state has a marketplace, this is your go-to for insurance shopping. Going to Healthcare.gov and entering your Zip code connects to your state marketplace or, if unavailable, the federal marketplace.

You can also buy directly from an insurance company or a private exchange. However, if you purchase from either of these sources, you won’t have access to premium tax credits.

What Are the Different Types of Healthcare Plans?

You’ll likely encounter unfamiliar terms when looking for the best health insurance plan. The most typical kinds of plans are:

  • Health maintenance organizations (HMOs)
  • Preferred provider organization (PPO)
  • Exclusive provider organization (EPO)
  • Point of service(POS)

HMOs and EPOs require in-network care, except in an emergency. PPOs and POSs don’t require staying in-network but will charge more for out-of-network providers.

HMOs usually require referrals, and POSs always do. PPOs and EPOs customarily don’t need referrals.

Read Your Summary of Benefits

A summary of benefits that explains the plan’s coverage and costs is usually accessible through a marketplace link. There should also be a provider directory of doctors and facilities participating in your plan.

When you have insurance through your employer, you can also access a summary of benefits. However, you must contact the company benefits administrator for this information.

Think About Your Family’s Overall Needs

Consider how much and what kinds of medical treatments your family has previously received. Unexpected medical needs might arise, but keeping past trends in mind allows for better planning.

Referral-Required Plans

HMO and POS plans requiring referrals require seeing your primary care physician (PCP) before visiting a specialist or scheduling a procedure. HMOs are available at a lower cost because the insurers only work with providers they contract with.

HMO and POS plans simplify everything by putting a PCP in charge of all your needs. If you have a POS plan, you can get a referral from your PCP when you see an out-of-network doctor, which lowers your costs. With an HMO, you can only get coverage out-of-network in emergency circumstances.

No-Referral Plans

Most EPOs and PPOs don’t require referrals. If you’re in a bigger urban area, EPOs can help you save money if you stay with in-network providers.

A PPO may be a better option if you live in a rural area. Remote areas with fewer providers may require going out-of-network to get care.

High-Deductible Health Plans

High-deductible health plans (HDHPs) can fall under the definition of any health plan. HDHPs have higher out-of-pocket costs while having lower premiums.

These plans allow the insured to open health savings accounts (HSAs). These accounts make it easier to pay for health expenses and offer tax advantages.

Check Out the Networks

The networks include facilities and doctors with contracts with insurance companies.

Are the Networks Important?

Going to an in-network doctor costs less because of the negotiated lower rates with insurance companies. Out-of-network doctors aren’t involved in these negotiations, which likely means higher costs.

How Do You Know If Your Current Doctor is In-Network?

You can ask your doctor’s office if they participate in a specific plan. Another way to see if a preferred doctor is covered is to check the provider directory.

How Big Should Your Network Be?

More extensive networks with more choices can be ideal if you don’t have preferred providers. If you’re in a rural area, a more comprehensive network might give you the choice you need.

It’s a good idea to rule out plans that lack local in-network providers. The more provider options in a plan, the better.

Health Plan Benefits

Your out-of-pocket costs, in addition to your premium, are essential considerations. The premium and deductible determine how much you’ll pay out-of-pocket.

Who Should Pay a Higher Premium?

Your out-of-pocket costs, like co-pays, are lower when you pay a higher premium. Plans with higher premiums are best for:

  • People with chronic conditions
  • Anyone who has an upcoming surgery
  • Parents with babies or young children or expectant parents
  • Anyone who takes expensive medications
  • Frequent emergency room patients
  • Frequent PCP or specialist patients

Who Should Pay a Lower Premium?

If you’re healthy and seldom need to see a doctor, a plan with a lower premium and higher out-of-pocket costs might be the better choice.

Choosing health insurance is one of the most important decisions you’ll make. The more you know, the better equipped you are to choose wisely.