On top of health insurance consisting of many options, it can also get expensive to have and maintain for yourself and your family. Yet, it is still critical now more than ever to be covered under a plan you trust that won’t break the bank. As your health insurance expert advisor, I want to share how to save money when choosing your health insurance plan (without sacrificing your coverage).
Want to save money on your health plan? Take a look at my five tips to follow when choosing the right health insurance plan for you (and your family).
Whether you are on the hunt for yourself or your entire family, you should know what options your employer offers when it comes to coverage. According to recent information provided by the Kaiser Family Foundation (KFF), “about 156,199,800 Americans (about 49%) rely on health insurance offered by their employer.”
Health insurance is seen as a significant benefit, but it can also be tricky to navigate when selecting the best plan for your money. An employer will typically offer three forms of coverage, including health, vision, and dental.
Health coverage can include full or partial coverage for hospital, emergency, or urgent care visits. It can also include doctor or specialty appointments and visits, prescription drugs, and preventive care.
Vision usually includes full or partial coverage for visits to the optometrist or ophthalmologist, eyewear care (i.e. glasses or contacts), testing, and other preventive maintenance forms related to vision.
Dental usually includes full or partial coverage for preventive care, routine exams, cleanings, and testing.
To help break it down further, you should analyze the following:
- Monthly payments made to keep your health insurance
- Co-Insurance Plan. Percentage of payment after your deductible
- Co-Payment Option. A fixed amount that you pay at the time of your visit
- Dual Coverage. Coverage provided by more than one provider (like health and dental)
You should also be aware of the Affordable Care Act (ACA). Signed into law and amended in two parts in 2010, the ACA intends to make healthcare available to more people, cover more adults with Medicaid, and support new health initiatives that lower coverage costs.
It may also help to know the significance of balance billing. This term refers to the amount you are directly billed after your health insurance has covered their allowed amount. For example, if a visit costs a total of $120 and your insurance covers $80, you may be billed the remaining $40. This is considered an out-of-pocket expense. However, an in-network provider may not balance bill you after a visit as the amount projected by your provider should be the accepted amount expected from your doctor.
Keep in mind that balance billing laws vary from state to state. Be sure to talk to a health insurance professional like me if you have questions about balance billing in your state.
Planning for coverage can be confusing. But what you need to know is that you are likely to be looking at a few key plan options available to you at different levels of coverage, including:
- Exclusive Provider Organization (EPO)
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
Exclusive Provider Organization (EPO) offers coverage for services done on an in-network basis. You do not need a primary care physician for this plan. In the case of a real emergency, an EPO plan might cover a portion of your out-of-network emergency visit.
EPO’s focus on preventive care to help make future care more affordable in the long run. However, if you are someone who sees specialists often, this may not be the plan for you as EPOs require prior authorization for specialist services.
EPOs tend to lean on the cheaper side than PPOs when it comes to sharing the cost of your visits (co-sharing), but it’s important to keep in mind that you may be limited in your choices of healthcare providers.
Health Maintenance Organization (HMO) plans cover doctors’ services working with HMO, usually in a specific area. With an HMO, you do need a primary care physician. But similar to an EPO, your HMO plan may cover all or part of a true emergency visit.
HMOs also focus on preventive care and tend to offer low out-of-pocket costs. Be aware that your HMO plan may offer cheaper premiums upfront, but cost more in the long run when paired with a low deductible.
Point of Service (POS) and Preferred Provider Organization (PPO) provides coverage for doctor visits within the plan’s network. You must receive a referral for specialists using POS to remain covered.
While you do not need a referral for a PPO plan, it may cost extra to see a specialist. You do get some added flexibility when it comes to searching for doctors or hospitals within a PPO network. And you may even be able to receive a small amount of coverage for out-of-network visits. However, it’s important to note that you will face higher premiums and annual deductible with a PPO. Depending on the plan, you will likely have the advantage of lower monthly payments.
Life is unexpected. You are often better off preparing for what’s possible by taking advantage of an HSA if you have a High Deductible Health Plan (HDHP). The purpose of this type of account is to allow you to put pre-taxed money away for a variety of qualified medical expenses when you need it most. You can use this money to help pay for copayments, deductibles, and other costs that might otherwise be expensive. While you cannot use an HSA to pay for premiums, other benefits are available, such as rolling over any unspent amount year-to-year. Be sure to ask your employer or health insurance agent about your options for an HSA.
If you have a plan that provides full or partial coverage for healthcare services performed in-network, it is vital to stay in the network. Of course, emergencies should take precedence over choosing in-network providers.
When you select a provider within your network, you opt for services that you know your healthcare provider works with to give you some form of coverage. By choosing healthcare services outside of your network, it means those healthcare workers do not have a pre-negotiated contract with your provider – meaning you will be subject to paying the full cost of any services done.
If you don’t have the time or would like someone to walk you through your options, contact me, Diana Reeves, for your health coverage needs to get started. Whether you’re self-employed, searching for family coverage, or requesting individual coverage, I can take you step-by-step to find the coverage that works best for your budget.
As an expert in the field, we provide free quotes with year-round availability to address all of your questions and concerns. Call me today to learn how to save money when choosing your health insurance plan.