There are so many health plans available in the market today. So how do you choose the right health plan? The “right health plan” differs from one family to another depending on your health care needs and financial capacity. First you have to choose which health care provider to go with; then you have to pick the type of health plan to purchase.
When you are presented with so many choices, it can be very overwhelming. My advice is to look at the insurance provider first. Choosing a reliable provider is very important. You wouldn’t want to end up with a good plan design (HMO, PPO, POS etc..) only to find out that your provider is not easy to deal with. These are some questions you should keep in mind while choosing among insurers:
- Does this company have a good reputation?
- Do they have good customer service? Are they easy to talk to? Do they respond promptly?
- Do they have good doctors in their network?
- Are they prompt in issuing refunds?
After you have decided on an insurance company, choose among the plans they offer.
If you’re looking for a cost-effective health plan with minimum out of pocket costs, you should go with an HMO (Health Maintenance Organization). This plan is ideal for those who often need to see a physician. HMOs however offer little freedom in choosing health care providers. Going out of the network requires you to pay for the services on your own. If you choose to go with an HMO, ask yourself if you are okay about getting care from physicians that are within the network only. Keep in mind also that HMOs require you to go through your primary care physician (PCP) each time you need to see a specialist.
If you want to have the option of going outside the network and you want to avoid the hassle of going through a PCP, a PPO (Preferred Provider Organization) plan is a good choice for you. PPOs do not require you to assign a PCP. You can go directly to specialists. PPOs however are more expensive and higher copayments apply for services received out of network.
POS plans are like HMOs and PPOs. You have the option to go out of network like in a PPO but it involves more out of pocket costs. Initially you will need to reach a deductible; after that, higher co-payments apply. You can save a lot by staying within the network. Like an HMO, If you need to see a specialist, you need to go through your PCP.
If you are after freedom and flexibility, you should consider Fee for Service plans. This plan allows you to get care from any health care provider. You initially pay for the medical costs upfront then your insurer pays you back for up to 80% of the cost.
If you want to pay a very minimal amount for your monthly premium, you should look into High Deductible Health plans. Every time you need medical care, you initially pay for your medical costs out of pocket until you have reached the deductible amount. Once you’ve reached your deductible, you only need to pay co-pays. This type of plan is ideal for those who are considered healthy and rarely need medical care. But in the event that something catastrophic happens, you can be assured that you have adequate coverage.
Author: Anne from VISTA Health Solutions. VISTA Health Solutions is a licensed insurance agency dedicated to meeting the needs of the individual, self-employed and the small business owner. VISTA Health Solutions specializes in self-employed health insurance, individual health insurance and Healthy NY plans.