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How to select the best health insurance policy to meet your needs

Emergency-Vehicles in a Row Outside Hospital-3323451_960_720-1When you’re hired by a company, it’s likely that you’ll be able to get health insurance through your employer. In America, 58 percent of people get their health insurance this way.

If your employer doesn’t offer health insurance or if you’re self-employed or do contract work, you can get health insurance through the Affordable Care Act.

In either case, you’ll need to pick out a policy. It’s a complicated process.

In addition, every year there will be an open enrollment period. That means you’ll be able to look at the different companies and policies your employer or the ACA offer to see if you want to switch.

Here are some tips to help you:

Compare the types of health insurance plans.

  • The kind you choose will help determine your out-of-pocket costs and which doctors you can see and which hospitals, labs, and pharmacies you can use. Eliminate plans that exclude your doctor or any local doctors in the provider network.
  • The different types of major medical plans usually offered by insurance companies are preferred provider organizations or PPO, health maintenance organizations or HMO, point of service plans or POS, or exclusive provider services or EPO.

PPO – Preferred Provider Organizations – A plan that has a special network or group of health care providers. You pay less if you use providers in the plan’s network. You may not need a referral from your primary care provider to see a specialist. This type of plan usually has payment options for using health care services that are in and out-of-network. Copayments are charged for each visit.

HMO – Health Maintenance Organization – A plan that only covers care from doctors who are part of the HMO. It generally won’t cover out-of-network care unless it’s an emergency. You may have to live or work in a certain area to be covered.

POS – Point of Service – A plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You will need to select a primary care provider for regular checkups and referrals to see a specialist. You can use out-of-network health care providers at a higher cost.

EPO – Exclusive Provider Services – A plan that covers services only if you go to doctors, specialists, or hospitals on the plan’s approved list or network. You can go to any provider in an emergency.

Compare costs.

  • Estimate the medical services you’ll use for the year ahead. Be sure to include co-pays for doctor's visits, prescription medications, and any procedures you might need. 
  • Compare the premiums, out-of-pocket expenses, and benefits under each plan. If you’re buying a policy from a state or federal marketplace, you’ll be able to do a side-by-side comparison of the plans offered on the exchange. All plans offered in the individual and small-group markets are required to cover 10 essential health benefits. The plans' summary of benefits and coverage will also help you figure out which plan offers the best coverage for your needs.
  • Look at insurance deductibles. Check to see if the plans have a separate deductible for prescription drugs. Know what services are subject to the deductible.
  • Decide how much you can afford to pay.

Compare prescription drug coverage.

  • Review the plan’s drug coverage and understand the difference in costs to you between any drug tiers the insurer uses.
  • Find out if there’s a different deductible for prescription drugs.

Remember that plans may differ in quality. 

Watch out for catastrophic health plans.

  • Be aware the premiums are very low and the deductibles are high. They pay only for the worst-case scenarios, such as getting seriously sick or injured. The deductible may be $8,000 – the amount you pay before anything is covered.
  • Be prepared to pay for most of your routine medical expenses yourself.

Get help.

  • Contact your state insurance department if you need help comparing plans or if have questions about your insurance company or the information it sends to you after you sign up for a plan.
  • See if the agency will tell you about complaints against insurance companies.


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