Regardless of the state of the economy or the ever tightening belts of employers, we have more healthcare options today than ever before. More options means more decisions and choosing the best healthcare plan for you or you and your family can be overwhelming at best. Whether you are choosing between employer provided coverage, private pay coverage, or Medicare coverage options, many factors should be considered before making a decision. Consider the following:
How much is the monthly premium?
What are the co-pays, co-insurance and deductibles?
Can you choose your own healthcare provider or do you choose from a list of approved providers?
Does the plan cover your specific needs such as specialists, vision, dental or chiropractic.
Do you need prescription drugs coverage?
Does the plan cover pre-existing conditions or is there a waiting period? If so, how long?
Do you need a referral for services other than your primary care physician?
How often do you need to see your doctor? Just for your annual physical or regularly to monitor an illness or condition?
Are you interested in preventative benefits such as gym memberships and weight loss plans?
To answer those questions, you need a basic understanding of healthcare insurance acronyms and jargon.
A premium is the amount you or you and your employer pay, usually monthly, to purchase the health insurance.
A co-pay is the amount you must pay for each service at the time of service, including prescription drugs. Co-pays can differ depending on the service. Specialist visits usually have a higher co-pay than visits with your primary care physician.
Co-insurance is a percentage of charges you pay when receiving covered services.
A deductible is the amount you have to pay before the insurance “plan” begins to pay. Deductibles vary widely, from no deductible to $5,000 or more.
Out-of-pocket-maximum is the total amount of co-pays and co-insurance that you for a prescribed period. After that period, the health insurance plan pays all expenses.
HMOs (Health Maintenance Organization) usually give you more bang for your buck. HMOs offer a higher level of care, a greater number of covered services, and lower out-of-pocket expenses than other health insurance choices. On the downside, all care and services must be within the HMO network of doctors, clinics and hospitals.
A PPO (Preferred Provider Organization) gives members the option of choosing a doctor or services in-network and paying a smaller fee or choosing an out-of-network doctor or services and paying a higher fee. Referrals for specialists are usually not required.
Advantage Plan refers to a non-traditional Medicare plan similar to an HMO. Although you lose some freedom of choice, you are rewarded with lower fees and expenses.
A pre-existing condition is any medical condition you have or had before your insurance takes effect. Recent laws require healthcare insurers to cover pre-existing conditions, but there may be a waiting period of up to 12 months. This means you pay for all medical expenses related to your pre-existing condition (such as diabetes or hypertension) during the waiting period while still paying the monthly premium.
The best health insurance plan for you is one that gives you the most benefits for the lowest cost, the most flexibility and fits your individual or family’s needs.