Open enrollment for health insurance is almost here and I want to make sure you’re totally prepared! Hopefully you read my first post about where to get your health insurance and you’re now ready to learn how to select a health insurance plan. Fun stuff!
So let’s talk this out and get you feeling more confident in preparing for open enrollment. So, what are the main things you should know when selecting your health insurance plan? Well, as a healthcare expert who secretly loves health insurance (I know… it’s weird), here are the top four concepts you should understand when selecting your health insurance:
1. Cost Sharing
4. Health Insurance Products
Now let’s discuss the four key health insurance essentials in more detail since you should know and understand these important concepts when selecting your health insurance.
1. Cost Sharing: the amount of money you must pay for medical care vs what the insurance company will pay. This includes things like deductibles, premiums, copayments, and coinsurance. Typically you want a lower deductible since you will have to pay those costs up front when you seek medical care but you have to balance it against the rest of the plan you are reviewing. It’s very important that you calculate your expected annual healthcare costs when comparing plans. My Health Care Transformation Handbook has tools to help you with this. And AVOID coinsurance and OPT for copayments. Coinsurance is a percentage of the bill while a copayment is a fixed amount. Imagine hitting up a fancy restaurant and eating tons of food without knowing the bill at the end. Would you rather pay 20% of the bill (coinsurance) or $20 (copayment)?
2. Benefits/Coverage:which medical services you can receive that will be covered under the health insurance plan.This ranges from who is providing the service (midwives, physical therapists, chiropractors, etc.) to where the service is provided (in the hospital vs outside the hospital in a clinic, skilled nursing facility, etc.) to how long the service can be provided (length of hospital stay for having a baby)- think what you get for your $$$. Make sure to review the benefits covered under a health insurance plan in comparison to what benefits you predict you will need. For example, are you planning on having a baby next year? What does the coverage look like?
3. Networks:the doctors and hospitals that will be covered or who will “accept” the insurance plan.This doesn’t mean you can’t go to someone who is “out of network” but it means your insurance won’t cover it and you will need to pay all the medical bills yourself, what we call in the industry “pay out-of-pocket”- think who you can see for less $$$. Before selecting your health insurance plan you want to check to see if your current docs are covered under that insurance plan.
4. Health Insurance Products: the overall type of plan you are purchasing. You will see acronyms such as HMO, PPO, EPO, etc. The HMO and PPO are the most popular types of products. The HMO requires you to select a primary care provider (PCP) who manages your care and must put in referrals to see specialists. The plan typically has a narrow network of providers who are covered. In a PPO, they don’t require you to select a PCP and the network is larger but gives you greater cost sharing.
So here’s the gist: you need to find a health insurance PRODUCT that includes the BENEFITS, or medical services, that you need with the NETWORK of doctors and hospitals that you want to see with a COST SHARING setup that fits your budget.
I know this is A LOT of information and it’s just barely grazing the surface. But no fear because I have many different resources to help support you in your open enrollment journey!
Attend an upcoming workshop + networking eventled by me- healthcare expert, Meghan Nechrebecki! Invest in your health!
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Read and use My Health Care Transformation Handbookto support you in managing your health while learning how to navigate the healthcare system.
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In the meantime, I'm so excited to be supporting you in your healthcare journey to achieve your best health at the lowest price.