Buying health insurance is an important and complex decision. Whenever you are considering insurance, it is important to research multiple plans to find the best insurance to suit your needs. Unfortunately, understanding health insurance plans is not easy. Every plan provides a different level of coverage. There are also different costs associated with each plan. On top of this, insurance providers often have different tiers available, which can drastically change how much you pay or the levels of coverage.
Another complication is when you apply for insurance, as well as when the benefits begin. With government insurance, such as Medicaid, you must enroll during a select period. These requirements are waived in certain circumstances, such as losing your employer provided insurance after being laid off. The majority of private insurance companies allow you to purchase coverage whenever you want, but you may have to wait for the coverage to start.
Understanding Insurance Terminology
Insurance plans use different terminology. Understanding the terminology is a key part of selecting the right plan. The base cost you pay every month is the premium. You must pay the premium whether or not you use the plan. A deductible is the total amount you must pay out of pocket each year before your insurance takes over. There are also copayments, which is a set amount you pay for specific services, such as a $20 copay for each doctor appointment.
Another type of payment is coinsurance, which is applicable after you reach your deductible. Your coinsurance is a percentage you must continue to pay for medical services. The rest of the payment is handled entirely by your insurance.
The last type of payment is your out-of-pocket maximum. This is the largest amount you pay out of pocket during the year. Once you hit this maximum, your insurance covers any future medical costs. Many insurance plans have two different maximums, one for yourself, and one for your family members.
Selecting an Insurance Tier
Most insurance companies provide different levels of coverage. If you purchase your insurance from your state marketplace, there are four different levels of plans. These are bronze, silver, gold and platinum. Typically, the lower the plan, the less you pay each month on your premium. In exchange, all your other costs are much higher. If you are on a fixed income or have minimal medical concerns, bronze and silver are acceptable tiers.
If you have preexisting medical conditions or want the best care possible, consider the gold or platinum plans. These plans are also recommended if you have multiple family members on the same insurance plan, since you naturally end up using your insurance more often.
In addition to different tiers, some private insurance companies allow you to select different policies. These policies essentially act as customized insurance plans, giving you a greater level of control over how much you pay. For example, you may be able to lower your monthly premiums by excluding dental coverage. You could also opt for a higher out-of-pocket maximum in exchange for lower payments.
Level of Coverage
The biggest decision you must make when selecting an insurance plan is how much coverage you want. When looking at an insurance plan, check to see what networks are included in the plan. If you are switching insurance plans, you may need to change doctors, if your new insurance is in a separate network. If you have ongoing medical conditions or attend physical therapy, be sure your insurance covers these services.
More comprehensive insurance plans include additional coverage for health issues, such as dental and vision. Another consideration is whether the insurance provides coverage for longer term care. If you have a family, make sure you understand what coverage is only available to you and what applies to your family members.
Blue Cross Blue Shield (BCBS)
BCBS is one of the largest insurance providers, which is reflected in the size of their insurance network. No matter where you live, there is a good chance you are near a medical facility in the BCBS network. BCBS also has generous insurance plans available at a discount for lower-income applicants. These plans are especially helpful if you do not qualify for government assistance, but are struggling with the average cost of private insurance plans.
United Healthcare
United Healthcare is considered one of the cutting-edge insurance providers because of the number of online options it provides. All of the plans include access to online care, allowing you to speak with medical consultants, participate in wellness programs and order prescriptions. You can also use the online tools to find a doctor or health specialist in your network to schedule an appointment. All of these features are also available through a mobile app.
Aetna
Aetna is another insurance provider with a large network. Aetna provides affordable plans, but do not sell any private insurance. Instead, the company sells Medicare, Medicaid, employer and student plans. If you are unable to receive coverage in the Aetna network, you are still able to use your insurance, but with limited benefits. Aetna also runs several wellness programs, only available to Aetna members. This includes health coaching, gym membership and weight-loss programs.
Kaiser Permanente
Kaiser is not one of the biggest names in health insurance, but they are quickly growing in prominence thanks to favorable customer reviews. One of the reasons Kaiser is becoming a popular health insurance option is the number of plans available. There are four categories of insurance plans, each with multiple tiers of coverage available. While it can be overwhelming to go through all the different options, it guarantees there will be a plan to suit your medical needs. As of writing, one of the downsides is the Kaiser network is not as large as some of the more recognized insurance agencies. If you are planning to switch to Kaiser from a previous provider, make sure your current doctors are in the Kaiser network.