Comprehensive Guide for Choosing Health Insurance

with Health Plus Life

how to choose health insurance
September 8, 2023 | Johanna Karlsson

Navigating the world of health insurance can seem complex, but by breaking it down to its foundational concepts, it becomes much more manageable. At HealthPlusLife, we’re here to help you understand the core principles of health insurance. If you’re looking for help figuring out how to choose health insurance, we’re always available to assist you with reviewing your options and ensuring you have just the right coverage. Before you call us to get started, let’s explore the basics of health insurance and the things you’ll want to consider.

Speak With a Licensed Insurance Agent
Call Now (888) 828-5064 TTY 711

Understanding the Basics of Health Insurance

Health insurance is a contractual agreement between you and an insurance company. In exchange for monthly payments known as premiums, the insurance company commits to covering certain medical expenses, either in full or in part. Think of it as a safety net, designed to protect you from high and sometimes unexpected medical costs.

But why is health insurance so crucial? Here are a few reasons:

  • Financial Protection: Medical treatments can be prohibitively expensive. With health insurance, you are safeguarding yourself against overwhelming medical bills.
  • Access to Care: Insured individuals often have easier access to a network of health professionals and receive timely medical care.
  • Preventive Services: Many insurance plans offer preventive services at no extra cost, allowing you to catch potential health issues before they become severe.
  • Peace of Mind: Simply knowing that you’re covered in case of illness or injury can provide immense peace of mind.

As you consider how to choose health insurance, you’ll come across specific terms that will frequently pop up. Here’s a quick breakdown of the essentials:

  • Premiums: This is the amount you pay for your health insurance every month, regardless of whether you use medical services or not. Think of it as a subscription fee that keeps your policy active.
  • Deductibles: Before your insurance starts to pay for services, you’ll first need to pay a certain amount out-of-pocket – this is your deductible. For instance, if your deductible is $1,000, you’ll pay the first $1,000 of your medical bills before your insurance kicks in.
  • Copayments (or Copays): A copayment is a fixed amount you pay for a specific service or prescription. For example, a doctor’s visit might have a $30 copay.
  • Out-of-Pocket Maximums: This is the most you’ll have to pay for covered services in a year. Your insurance will cover the rest once you’ve reached this amount (through deductibles, copays, and other expenses).

How to Choose Health Insurance: Assessing Your Needs

Selecting the right health insurance isn’t just about comparing costs; it’s also about aligning your coverage with your health and lifestyle needs. Just as one size doesn’t fit all in fashion, the same applies to health insurance. Here at HealthPlusLife, we’re committed to guiding you in your quest to find the best fit. Let’s walk through the process of evaluating your needs. Start by considering:

  • Routine Medical Care: How often do you visit the doctor? Do you need regular check-ups, or do you have monthly or quarterly appointments for ongoing conditions?
  • Prescription Medications: Are there medications you take consistently? Or do you foresee needing specific medications in the future?
  • Specialist Visits: Do you need to see specialists such as cardiologists, endocrinologists, or physical therapists regularly?
  • Anticipated Procedures: Are you planning any surgeries or medical procedures in the coming years? Whether it’s elective surgery or a potential need, it’s worth noting.

Life is a journey filled with significant milestones, and each phase may influence your health insurance needs. Remember to also consider these life changes:

  • Marriage: Tying the knot often means thinking about combined health insurance plans. Some couples find it beneficial to stay on separate plans, while others benefit from a combined plan. It’s worth reviewing your options regarding individual and family health insurance plans.
  • Children: Welcoming a child, whether by birth, adoption, or fostering, can change your insurance priorities. You’ll need to factor in pediatrician visits, vaccinations, and other child-specific needs.
  • Retirement: As you approach retirement, you may have different medical needs and will need to think about transitioning from employer-provided insurance to other options.

As we age, our health needs evolve. Adults and seniors may have specific considerations:

  • Chronic Conditions: With age, the risk of chronic diseases like diabetes, hypertension, or arthritis might increase. Ensure your plan covers treatments and medications for these conditions.
  • Vision and Dental Care: While younger adults might skip on vision or dental coverage, it becomes essential as we age. Regular eye and dental check-ups can catch issues before they escalate. And remember, if your health plan doesn’t cover these components, you’ll want to consider adding dental insurance plans and vision insurance plans.
  • Mobility and Physical Therapy: Maintaining mobility and strength is vital. Insurance that covers physical therapy or mobility aids can be beneficial.
  • Specialist Consultations: Seniors might need frequent consultations with specialists, like geriatricians or rheumatologists. Ensure your plan provides ample coverage for specialist visits.

Speak With a Licensed Insurance Agent
Call Now (888) 828-5064 TTY 711

How to Choose Health Insurance: Types of Plans Available

health insurance criteria

Each type of health plan provides different levels of flexibility, choice, and cost structures. Let’s break them down:

  • HMO (Health Maintenance Organization): HMOs are designed around a network of doctors and health providers. With an HMO, you generally need to select a primary care physician (PCP). This PCP will be your main point of contact and will give you referrals to see specialists. HMOs usually don’t cover care outside their network unless it’s an emergency. They often have lower premiums but require more coordination.
  • PPO (Preferred Provider Organization): PPOs offer more flexibility when picking a health care provider. You don’t need a referral to see a specialist. While you can see any doctor or specialist you want, staying within the plan’s network will save you money. PPOs often have higher premiums but provide greater flexibility.
  • EPO (Exclusive Provider Organization): EPOs are a mix between HMOs and PPOs. They offer the flexibility of seeing any specialist without a referral. However, they don’t cover care outside their network, barring emergencies.
  • POS (Point of Service Plan): POS plans combine features of HMOs and PPOs. You need a referral to see a specialist, but you can go outside your network for care, although at a higher cost. The emphasis is on coordinating care through your primary care physician.
  • High-Deductible Health Plans (HDHPs): HDHPs, as the name suggests, come with a higher deductible than typical health insurance benefits plans. This means you’ll pay more health costs yourself before the insurance company starts to cover costs. However, HDHPs have lower monthly premiums, making them an attractive option for those who don’t expect to use medical services frequently.
  • Health Savings Accounts (HSAs): HSAs are tax-advantaged savings accounts, specifically for people with HDHPs. Money you contribute to an HSA is tax-deductible and can be used tax-free on eligible medical expenses. It’s a way to set aside money for future health care expenses, from doctor visits to prescription medications.

Factors to Consider When Choosing a Plan

  • Accessibility & Convenience: Start by checking if your current doctors and preferred hospitals are within the plan’s network. It’s comforting to continue seeing professionals you trust and have built relationships with. Plus, sticking to in-network providers will generally save you money.
  • Specialist Coverage: If you have specific health concerns or conditions, make sure that specialists in those areas are easily accessible within the plan’s network. The ease of getting referrals to see them, if required, is another consideration.
  • Geographic Spread: Especially important for those who travel frequently or have homes in multiple states. Ensure the plan offers an expansive network or provides good out-of-network coverage.
  • List of Covered Drugs: Insurance plans often have a “formulary” or list of covered medications. If you’re on regular medications, it’s essential to check if they are on this list and what tier they fall into, which can affect their cost.
  • Pharmacy Options: Some plans might require you to get your prescriptions from specific pharmacies or offer better discounts at certain chains. It’s also worth looking into mail-order options, which can be cost-effective and convenient for long-term medications.
  • Special Approvals or Steps: Occasionally, insurance providers may have additional requirements before approving certain medications, like trying a cheaper alternative first. Being aware of these can save you both time and potential disruptions in your treatment.
  • Vision & Dental Coverage: Not all health insurance plans automatically include vision and dental coverage, especially for adults. If these are important to you, look for plans that either incorporate them or allow you to add them on for an additional cost.
  • Wellness Programs: Many insurers now provide wellness programs as part of their packages. These can range from weight loss support and smoking cessation programs to discounts on gym memberships or even rewards for routine health screenings. Such features not only promote a healthier lifestyle but can also result in cost savings in the long run.

Financial Considerations and Your Budget

When considering how to choose health insurance, understanding the associated financial implications is crucial.

  • Deductibles: This is the amount you pay out of pocket before your insurance kicks in. If you choose a plan with a higher deductible, your premium might be lower, but you’ll pay more upfront when you access medical services.
  • Copayments: These are set amounts you pay for specific services, regardless of the total cost. For instance, you might pay a $30 copayment every time you visit your primary care physician.
  • Coinsurance: This is your share of the costs of a healthcare service, calculated as a percentage. For example, if your insurance covers 80% of the cost of a procedure, you’ll pay the remaining 20%.
  • Annual Maximums: It’s crucial to check if the plan has an out-of-pocket maximum. Once you reach this amount (which includes deductibles, copayments, and coinsurance), the insurance will typically cover 100% of additional costs for the year.
  • Uncovered Services: Be wary of treatments or services that aren’t covered by the plan. These can lead to unexpected costs. It’s always a good idea to check with your insurance provider before undergoing any significant procedure.
  • Medications: As previously mentioned, ensure your medications are covered. If not, you might find yourself paying full price, which can quickly add up.

How to Choose Health Insurance: Making the Final Decision

Start by reviewing the Summary of Benefits and Coverage (SBC), a standardized document that health insurance providers must give to potential enrollees. It provides a comprehensive overview of what the plan covers and what it costs. Here’s what to look for:

  • Coverage Details: Ensure the services you need, from preventive care to major surgeries, are covered.
  • Limitations and Exceptions: Some plans might exclude certain procedures or have limits on the number of visits or treatments you can have in a year. Make sure you’re aware of these.
  • Examples of Care Costs: Many SBCs include scenarios, like childbirth or managing type 2 diabetes, to show potential out-of-pocket costs. These can be helpful in gauging potential expenses.

Changing or Renewing Your Health Insurance Plan

The journey to optimal coverage doesn’t end even if you’ve made up your mind after considering how to choose health insurance. As you navigate your way through life’s various phases, it’s essential to be aware of how and when you can change or renew your insurance to ensure it always aligns with your requirements.

  • Open Enrollment Period: This is the most common time people change or pick a new health insurance plan. Usually occurring once a year, the open enrollment period is a specified window when you can make unrestricted changes to your health insurance coverage. Typically, open enrollment for health insurance occurs in the fall. Exact dates can vary each year, so it’s vital to mark your calendar or set a reminder. If you’re dissatisfied with your current coverage, this is the ideal time to shop around. HealthPlusLife offers tools and resources to help compare various plans and find one that’s right for you.
  • Special Enrollment Periods (SEPs): Life doesn’t always stick to a schedule. If you experience significant life changes, like getting married, having a baby, or losing other health coverage, you qualify for a Special Enrollment Period. This allows you to change your insurance outside of the regular open enrollment period. Not every life change qualifies for an SEP. Make sure to review the criteria and see if your circumstances allow for a change. SEPs are typically time-limited. If you qualify, make the necessary changes promptly.

As we age, our health needs can shift. Perhaps you require additional medication, or maybe you’re in need of specialized services or treatments. Regularly assessing your health and how well your current plan caters to your needs is crucial.

  • Annual Health Check: Consider an annual health review. Reflect on any new diagnoses, medications, or treatments you’ve had in the past year. This will give you a clearer picture of your needs and whether your current plan meets them.
  • Family Health Needs: If you have a family plan, it’s not just about your health. The needs of your partner or children can change, too. Regularly review the health status of everyone under your coverage.
  • Financial Shifts: Over time, you may find that your budget for health expenses has changed. Maybe you’re more financially stable and can afford a plan with better benefits, or perhaps you need to find something more affordable. Keep an eye on your financial health alongside your physical health.

In conclusion, the world of health insurance is dynamic, and staying informed is key. Whether you’re reevaluating during open enrollment, navigating an SEP, or simply checking in on your evolving health needs, HealthPlusLife is here to guide and support your journey. Your health is invaluable, and we’re committed to ensuring you always have the coverage you need. Call us at 888-828-5064 or contact our team online today to get started.

Johanna Karlsson
Johanna Karlsson is a veteran health and life insurance professional licensed in 50 states. She relocated from the countryside in the south of Sweden and has not looked back. After coming to the United States to attend university, she gained her degree in Public Relations. She brought her public relations skills to a local international health insurance where she discovered a new passion in insurance. After years with that company, Johanna now joins HealthPlusLife to help build a team of licensed insurance agents ready to meet your insurance needs.