Make wise purchases
It can be difficult to choose health insurance whether you are purchasing it from your employer or not. Nearly half of employers that employ 200 or more people offer multiple plans. Each plan has different premiums, copayments and benefits. These tips will help you select the best insurance for your family.
Take Care of Your Health
You should choose a plan that has a lower deductible or lower copayments if you have a medical condition that requires ongoing care. The same applies if you are thinking about having a baby within the next year. While you’ll be paying a higher premium than your out-of-pocket expenses, your total cost may be lower.
Do the math.
While most people focus on the monthly premium only, it is important to consider the deductible as well. If you are faced with the choice of a silver plan premium that is $345 per month and has a $5500 deductible or a gold plan premium that is $465 per month with a $1750 deductible, then you should choose the second plan. This plan will be more cost-effective if you expect to need more than $1500 in medical treatment. The second plan’s annual premium and deductible total $7,330. This is a $2310 savings over the lower premium plan.
Take a look at your out-of-pocket expenses.
You also have copayments, coinsurance and the deductible. These three are your maximum out of pocket costs. The Affordable Care Act limits your maximum out-of pocket costs to $7,150 per person and $14,300 for a policy for a family.
Check out the list of providers.
Today, most health plans have “in-network providers”. You pay less out-of-pocket if you visit these doctors and those hospitals. If you’d like to keep your doctor, and visit a particular hospital, ensure they are on the provider list.
Check out the benefits.
Individual and small business plans must cover hospitalization, laboratory tests, maternity care, newborn care, mental and substance abuse treatment, outpatient (doctors and other services not provided by the hospital), pediatric care (including vision and dental care), prescription drugs and preventive services. However, the details of your employer’s plans may be different. Make sure you read the Evidence of Coverage.
Take a look at the drug listing.
Every plan has a formulary. This is a list of the medications covered and the copayment. Check the formulary if you are taking prescription medication. You will find out how much it will cost to refill your prescription. You may be required to pay full price for your medication if it is not on the formulary. You may also be able to save money by having your prescriptions mailed in.
Ask the right questions.
Talk to the member services department for the health plan that you are considering, or with someone from your human resources department, and ask: What doctors, hospitals, clinics, or pharmacies are part of the plan? What is the cost of going out of network? What is my travel insurance? What are the out-of-pocket and premium costs? How much will I have to pay from my pocket to cover expenses? What benefits are included in the plan? What happens if there are any disputes regarding a bill or service?
Verify the quality of the plan.
You can easily check the quality of your plan by clicking a few buttons. The National Committee for Quality Assurance ranks all health plans in the country based upon their clinical performance, member satisfaction, as well as results from NCQA surveys.