For many of us, health insurance is a critical part of our overall healthcare. With many states now passing legislation for mandatory health insurance coverage, this leaves many of us scrambling to make sense of which health plan is right for us. Health insurance plans can vary dramatically in their amount of coverage for primary care, testing and procedures. Given the rising cost of healthcare, this deficit is offset by offloading some of those costs to the consumer. What does this mean for you? Higher premiums, which is why it pays to shop around and look at the fine print closely.
What to Look for
Insurance plans can be divided into 3 broad categories: HMOs, PPOs or EPOs. An HMO forces patients to pick healthcare providers within their network. This translates to reduced costs for each patient. If you have your heart set on choosing a particular primary care physician (PCP), make sure that this PCP is within the network with which you plan to be covered. If avoiding the hassle of referrals from your PCP, or sticking to doctors within a certain network is important to you, then choose a PPO. These plans do not require you to see your primary doctor first before consulting with a specialist. In fact, some PPOs do not require you to even choose a PCP, although this is probably a bad idea for most people, as your PCP can help coordinate all of your healthcare needs as well as provide preventative healthcare. One caveat to PPOs, however, is that all of your medical bills are your ultimate responsibility and the PPO may only partially reimburse you for some tests that you have had one. EPOs are similar to PPOs, but they offer more limited choices in choosing providers. However, their rates are often more discounted than a PPO. Insurance plans also vary in terms of their prescription coverage. If you are elderly or have chronic medical conditions, it may be wise to choose a plan with the lowest co-pays for prescription drugs. Co-pays for office visits and ER visits also vary widely from plan to plan. If you are someone who requires frequent trips to your doctor, make sure that you don't choose a plan that charges high co-pays per visit. Another factor to consider is the dreaded deductible. An annual deductible is usually a dollar amount that you have to pay out-of-pocket per year before your insurance coverage kicks in. Make sure that you know your deductible and are able to afford this fee.
Common Pitfalls
Many people, especially those who are young and healthy, assume that they don't need healthcare coverage. They make the common mistake of taking more time to research their auto insurance and pay more for their auto coverage than they do with their own health insurance. The leading cause of injury and death in young adults is accidents. Unfortunately, a serious accident can leave many of us with a lighter wallet and a huge debt. Take an honest look at your overall health and the amount of office visits or testing that you have required every year for the past few years. If you have serious chronic medical conditions or you make frequent doctor's appointments, or are over the age of 65, it may be wise to pay a higher premium and reap the benefits of more comprehensive coverage. This will help you avoid a financial disaster in case you require a lengthy hospital stay, expensive testing or surgery.
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