How to Choose a Health Insurance Plan?

Individual and Family Health Plans

choose a plan

Why You Need Health Insurance Plans?

There are multiple types of Health Insurance plans that an individual can enroll in. The purpose of a health insurance plan is to protect the insured from the high cost of medical bills in case of illness or emergency. In other words, a health insurance plan transfers the risk from the insured to the insurance company. To use a better term, the risk is shared between the insured and the insurance company. Although the insured is still responsible for paying a co-payment or co-insurance, yet the insurance company is paying the difference in claim.

What Are the Common Terms in Health Insurance?

You have probably heard these terms many times before and stared against the wall wondering the meaning. I will simplify it for you in the table below. If we miss a term or you have a questions about a particular term, just contact us via question form below.

 Term  Meaning
Premium The periodic payment to an insurance company for health coverage
Coinsurance An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%)
Copayment An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
Metal Plans have different metals, Bronze, Silver, Gold, or Platinum. Each metal has a difeerent deductible, copayment, and coinsurance.
Deductible The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
Formulary A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
Primary Care Doctor The doctor you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them. In many Medicare Advantage Plans, you must see your primary care doctor before you see any other health care provider.
Service Area A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it’s also generally the area where you can get routine (non-emergency) services. The plan may disenroll you if you move out of the plan’s service area.
Subsidy Savings towards the monthly premium received based on the individual income

What to Prepare Before You Start Looking At Plans?

Before you start looking and comparing health plans you need to do have the following ready and handy. Whether you are working with an insurance agent or not, you need the below information ready before you start your insurance plan search. This will help you narrow your search for the best health plan, as well choosing the health plan.

  • List of all your doctors and those of your dependents. 👩‍⚕️
  • List of all the medications you take.💊
  • List of the hospitals where you usually go to for medical services. 🏥
  • Current insurance plan cost per month (if applicable) 💰

 

Finding the Best Plan:

Now that you have all your doctors, medications, and hospitals you can search for plans that consider the latter in network. It is important to find a plan that have all your providers or medications in network, otherwise your health services like: doctors visits wont be covered. Or if the plan you choose allows for an out of network services, the plan will pay for the health claims but an out of network rate. An out of network rate is almost double the cost sharing for the in network rate.

 

  1. Enter all your Medications
  2. Enter all your providers
  3. Enter your hospital (if applicable)
  4. Filter Plans by network accepting your providers.
  5. Then Filter by Premium and Deductible ranges
  6. Choose the plan that is accepted by your doctors, have most your medications on formulary, and is financially feasible to you and your family.

If you find the process to be daunting or you are confused between couple of plans, you can schedule a call with our agents to get your enrollment streamlines. Our insurance agents can answer all your questions and help you find the health insurance plan that fits your needs.

Now you can ask us a question!

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