Every year whether you are employed or not, there is a time when open enrollment for health insurance opens up. The time is limited, and that may make some feel pressured to make a decision. But making that decision in haste may end up being a bad thing.
That is at least what I experienced as I skimmed multiple options during the last enrollments. So I want to share with you what I learned when it comes to choosing the best health insurance for you.
- Looking at the Marketplace
- Comparing Plans
- What About Networks?
- Are There Out of Pocket Costs?
- Look at the Benefits
- Where and When to Enroll?
- How Often Do You Use It?
- Things to Look Out For
- If All Else Fails, Go to a Professional
- How to Save Money On Your Plans
Looking at the Marketplace
If you are a full-time employee at most companies, you will be given insurance.
This is the easiest way to go because the insurance through your employer will be less expensive.
If, however, you are like me and only work part-time, you will need to dive into the insurance marketplace to price out options for you.
You can skim the private market place which will, as I learned, cost you a pretty penny, or you can try your state or federal marketplace.
If you go to HealthCare.gov, you will be able to find your state marketplace way easier. This is a viable option that I found pretty informative.
I also took a look at the federal marketplace. The only other option when it comes to market places is the private exchange.
This is where you go through the health insurance provider themselves. This option has a lot of drawbacks, including the fact you won’t be able to use the premium tax credit to reduce your costs.
When I started to look into getting health insurance, I got really confused about the types of plans.
I am sure that I am not the only one, and understanding the plans is vital to choosing the right option for your health needs.
There are four different policy plans that you can choose from.
- PPO: You can go outside the network of doctors but staying in the system will be cheaper. You don’t need referrals for specialists. This gives you more options but will cost more.
- EPO: With this option, you will be able to go out of the network of doctors except when it comes to emergencies. You don’t need a referral. There is a limited choice of providers, though.
For the next two options, you need referrals for certain appointments and services.
- POS: You can choose doctors out of the network, but staying with in-system doctors will be cheaper. This plan will require referrals specialists.
- HMO: You will have to stay in the network and also need referrals for specialists. Typically these are the cheapest option, but you won’t have a lot of freedom.
What About Networks?
What are these networks that we keep talking about?
This was something I didn’t understand either, but it is something that when looking to choose the right insurance, you need to understand.
In-network doctors mean that they are doctors that have negotiated a discount with the insurance provider.
Staying in-network typically means lower rates, but with some of the plans, you will be able to also venture outside of the network.
What Does This Mean?
That means if you have a doctor you prefer to go to, like many of us do, before you choose the plan and provider, you may want to check if they are accepted.
For me, I didn’t really have a preferred doctor, and so when I looked at the providers, I wanted a plan that had a large network of doctors to choose from, so I had plenty of choices.
You can also look to see if any of the plans don’t offer you any local in-network doctors.
Are There Out of Pocket Costs?
Most plans will have some sort of out-of-pocket costs, and that can play a role in your budget.
When choosing the plan, you need to compare these costs to make sure that it fits into that budget.
If you really want a good place to see a large snapshot of this, you can try taking a look at the state and federal marketplace websites.
I had to become acquainted with a couple of terms—things like deductible, co-payments, and co-insurance.
What Do These Mean?
A deductible is a set amount that you have to pay up when it comes to the bill. The co-payment is the fee that you pay when it comes to doctor’s appointments and medications.
The last term co-insurance was the one I didn’t really understand. This is the out-of-pocket expense that you have to pay after the deductible.
When you see these snapshots, there will be a minimum and maximum out-of-pocket expenses, and that will contain all of these numbers.
Look at the Benefits
Once you have looked at providers, plans, and out-of-pocket expenses, you can then begin to compare the benefits that you get with the plans you have left on your list.
I really looked at each of the services that are provided by these plans.
Do I have access to PT? What about mental health care? Not every health insurance plan offers you access to these services.
Depending on your needs, this could be the defining feature that helps you make your final decision. For me, I wanted access to mental health care, and that narrowed my field down even further.
Needs and Options
There will be some questions that you have that you may not be able to answer by looking at the provider’s websites or the marketplaces.
So once you have it down to this, you can always reach out and contact the providers to finish answering all your questions, which I had to do when it came to specific medications that I took.
So if you have special medication, this may be the next step for you too.
Where and When to Enroll?
After all of that research and with a handful of plans in mind, you will then want to figure out when your enrollment period is.
Because there are state-run marketplaces, this may vary. Typically though, the open enrollment period is from the beginning of November until the middle of January.
For those that have state-run marketplaces, you may have longer to enroll. There are also special enrolment periods for certain circumstances.
Do You Qualify?
To find out if you qualify for one of these, you will want to contact the customer service for the provider or your local state health officials.
If you have health insurance offered through your employer, the enrollment period usually is after the first 90 days of employment.
Typically, you have a set amount of days to sign up for the plan to work for your health needs. Most of these will give you a choice between an HMO and PPO.
How Often Do You Use It?
The features and benefits of the health insurance plan are important, but there are a few things I realized you need to think about as well.
One of these is the frequency at which you actually use your insurance. If you have a list of illnesses or medications you need to take, that can easily affect your choice.
However, if you are pretty healthy, then you may not need as much access to certain things.
This means that when you are going over the benefits, you might be able to leave a few of them off of your plan needs.
This will save you some potential out-of-pocket costs and leave you with reduced monthly payments.
One good thing about a lot of the sites I used in my hunt is that you can enter in your health issues and medications to ensure that the provider and plans cover those.
This helped me from spending too much time on plans that wouldn’t fit my needs.
Things to Look Out For
There are many choices out there, and you may see many ads for plans that seem like a good idea.
They offer lower costs and more coverage, and that is appealing to us all.
But you have to be careful because, just like with everything else, sometimes there are options that are too good to be true.
Often these plans are short-term, and they do cover some things, but they may not offer the ten essential benefits the ACA plans do.
I ran across a couple of these and what I really learned is that you have to read all the fine print. So take your time when looking at plans like this.
Recently there have been some upgrades on sites that show you insurance plans that may help keep you from spending too much time on these plans.
Many of the sites have gone to star rating systems like other review sites online use. This might help you weed out the bad ones.
If All Else Fails, Go to a Professional
In the end, I was able to find a plan that worked for all my needs, but if you weren’t able to get it narrowed down to one, then you can always reach out to professionals.
There are sites and professionals that can be found via a health insurance navigator or counselors.
These professionals are not affiliated with the providers, giving them a subjective view on what plans are best for you.
They will look at your needs and your budget and help you find a plan that works with both. This is key so that you can take care of your health the right way.
What You Need
If you have to go this route, then you will need to make sure you have all your documents ready.
Things like your social security card, immigration document (if you have them), and tax returns will be used to find your health insurance plan.
Having all this paper assembled will make the process of choosing your plan easier.
How to Save Money on Your Plans
Health insurance is pretty darn important, but you also have to be able to afford it. You don’t want the plan that you choose to send you into debt every time you use it.
So if you are looking to save money, you should definitely make sure you do your research using all the information I discussed above.
Having an idea of what to look at and what the terms mean will help you be able to manage the cost more efficiently.
You want to make sure you look at multiple sites to find the best plan option when it comes to costs. Not only different sites, but make sure you look at numerous different providers.
A great way to save some money is to look at subsidies.
If you go through a health insurance portal either with your state or the federal government, there are steps that can be done to make sure that you are getting the lowest cost possible.
You can also look at health insurance alternatives like short-term insurance.
I know that when I was looking for insurance, I spent a lot of long nights scrolling through site after site, and it got pretty frustrating.
So I hope that my experience and knowledge that I collected on my hunt can help you. Having good health insurance is super important, and it doesn’t have to be a challenging experience.