Finding the right health insurance plan for yourself or your family can be challenging. With so many plans available in the market, finding the best coverage is confusing at best. When selecting individual and family health insurance plans, you must consider several factors, such as the marketplace, cost, coverage, network size, and other benefits.
So how do you know which plan is right for you? Here are a few tips to help you out.
Tip 1: Choose Your Marketplace
Check Your State
The first step in finding the perfect individual and/or family health insurance plan is to choose the right marketplace. Most states have their own marketplaces, so you will need to research which ones are available in your area. It is also important to look into any state subsidies that may be available to help cover the costs.
The bottom line is that the availability of health insurance options can vary greatly depending on each state’s regulations. This is because every state holds a considerable amount of authority over health insurance regulations within its borders.
For example, even though all states are subject to portions of the Affordable Care Act (ACA), some states may offer their own individual marketplace. This type of marketplace offers coverage for individuals and families with plans that meet ACA standards.
Then you have other states that have their own state-run marketplaces offering a variety of plans and programs beyond the minimal requirements.
Ask Your Employer
A second option is to receive health insurance through your employer. Oftentimes, employer-sponsored health insurance plans are much more affordable than signing up for health coverage on your own—especially if you work for a company with more than 50 employees.
This is because federal law states that companies with more than 50 employees must pay at least 60 percent of their employees’ health insurance premiums.
Generally, an employer will provide a selection of plans from various insurance providers for you to choose from.
However, if you find that the plans don’t tick all the right boxes, you can decline employer health insurance with a waiver of coverage. But waiving employer-sponsored health insurance also means:
- Losing employer financial assistance to cover health insurance costs
- Becoming ineligible for health insurance premium tax credits
- Potentially becoming subject to a penalty if you don’t obtain coverage on your own
- Becoming ineligible to enroll until the next open enrollment unless you’re covered under another plan
- Being subject to pre-existing condition limitations when you finally enroll in another plan
Private Exchange or Direct from an Insurer
Finally, there are private exchanges. These exchanges are run by privately held companies like brokerage firms or large insurance carriers. Some advantages of using a private exchange include:
- Increased individual health insurance plan options
- Increased cost-control
- Personalized support team
Going with a private exchange is beneficial for those wanting more control over their coverage options. Unlike public exchanges, where you can only find ACA-compliant plans, private exchanges offer other benefits and add-ons like vision plans, catastrophic plans, dental coverage, fertility benefits, wellness services, and more.
By working with a private exchange, you also receive personalized support because you’ll be working directly with a licensed broker. This is extremely beneficial because brokers communicate with insurers on a daily basis and have detailed knowledge of the private insurance options that each insurer can offer.
This means that you can work with a knowledgeable broker to find the most affordable health insurance coverage for you and your family.
You can also go directly to an insurer for individual and family health insurance plans if you want even more control over your coverage. One of the advantages of going this route is that you’ll know exactly what kind of benefits each plan offers.
For example, if you go with Redirect Health, some benefits you’ll get access to include:
- Affordable premiums
- $0 copays on routine care
- Inclusive low-cost prescription drug coverage
- A vast network of over 700,000 providers
- $0 mental health tele-visits
- Low-cost imaging
- And more!
Plus, if you’re looking for additional benefits, you can speak with a Redirect Health Healthcare Consultant to help create a customizable plan that best suits your needs.
Tip 2: Compare Plans
When searching for the best individual and family health insurance plans, you’ll encounter an alphabet soup of options. To make sense of it all and figure out which plan is right for you and your family, you must consider a few key factors.
First, decide if you want a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), an Exclusive Provider Organization (EPO), or a Point-of-Service (POS) plan.
Health Maintenance Organization (HMO)
An HMO, like a PPO and EPO, is a type of managed-care plan. Each HMO plan will have its own network of providers that accept a preset fee to keep your medical treatment costs low. However, if you decide to get treated by an out-of-network provider, the HMO plan will not cover anything, in which case you would be responsible for the entire bill.
- No additional fees beyond the copay for in-network specialist referrals
- More plan options with no deductibles
- Primary Care Physician (PCP) coordinated care
- Lower premiums than PPOs
- Smaller selection of providers
- May have to live in an HMO-eligible service location
- Only medical emergencies are covered if treated by an out-of-network provider
- Must be referred to a specialist by your PCP
- May lose access to your preferred provider if they aren’t in-network
An HMO may be right for you if your preferred provider is already in-network, you rarely travel further than your covered network area, and you require coordinated care.
Preferred Provider Organization (PPO)
A PPO plan is a type of managed-care health plan that allows members to pay lower fees if they’re treated by in-network providers. Depending on the PPO plan, visiting in-network providers may mean not paying copays or any other out-of-pocket costs.
- PCPs are optional
- No referrals to specialists required
- You’re covered even when you’re traveling out of state
- Depending on the plan, you may have access to an increased number of services
- Pays partial costs for out-of-network treatment
- Generally higher premiums
- Higher likelihood of an annual deductible
- Potentially higher coinsurance percentage
- Potentially increased paperwork
- Responsible for self-coordinated care
Exclusive Provider Organization (EPO)
An EPO plan is also a type of managed-care plan that covers services from in-network providers. However, most EPO plans won’t contribute anything towards out-of-network costs unless it’s for emergency care—similar to HMO plans.
- Large networks.—EPO plans generally offer wider networks than HMO plans.
- Average monthly premiums. EPO plans generally have lower premiums than PPOs but higher premiums than HMOs.
- Increased control. You can find plans that don’t require a PCP or referral to see a specialist.
- Higher deductibles for lower monthly premiums
- No out-of-network coverage unless it’s a medical emergency
Tip 3: Compare Networks
When searching for the best individual and family health insurance plans, it’s important to compare and contrast health insurance networks. A network of providers is a long list of hospitals, physicians, and other healthcare providers that accept an insurance company’s terms and conditions.
Most major health insurers offer PPO, and HMO plans with an exclusive network of doctors, specialists, pharmacies, and hospitals. For example, Redirect Health’s individual and family health insurance plans come offers members access to over 700,000 providers nationwide.
It’s also important to make sure that the plan you choose includes your preferred doctor, hospitals, specialists, and pharmacies. Having access to a doctor who understands your medical history and knows you personally can be invaluable when it comes to obtaining the best care possible. Redirect Health understands the importance of established relationships with doctors and allows members to add their own doctors to their plan.
Having a trusted primary care provider can also help you avoid costly trips to the ER for urgent medical care. Having access to a wide range of in-network providers means that you can find the best doctor or specialist for your needs without having to go out of pocket.
If you need treatment from an out-of-network provider, some health plans will still cover a portion of the costs so that you don’t have to bear the full financial burden.
Tip 4: Compare Costs
When it comes to selecting the perfect affordable health insurance, cost always plays a major factor. Different plans come with varying price tags, and you need to decide which one fits your budget. The most common costs associated with health insurance are copays, deductibles, coinsurances, out-of-pocket maximums, and premiums.
Copays are an important factor to consider when comparing individual and family health insurance plans. Copayments are a fixed dollar amount you must pay when you receive a service or fill a prescription. Generally, the higher the copayment, the lower the premium amount. Copays are typically due at the time of service, but some plans may require them before you use a service. Redirect Health provides plans that have removed copays from all routine care costs to save on these types of expenses.
Deductibles are the amount you must pay each year before your health insurance plan begins to cover any costs. Deductibles vary depending on the type of plan you choose and can range in price from as little as a few hundred dollars to several thousand dollars.
Coinsurance is the portion of your medical bills that you’re responsible for paying after you’ve met your deductible. Coinsurances are often expressed as a percentage and typically range between 10 and 90 percent, depending on the plan.
For example, if you have an individual health plan with a coinsurance rate of 20 percent, then you will be responsible for 20 of the medical costs after meeting the deductible. It’s important to factor in coinsurance rates when comparing different health plans, as it can make a big difference in your wallet.
Out-of-pocket maximums are the most you will have to pay for covered medical expenses in a calendar year. This includes copayments, coinsurance, and deductibles, but it doesn’t include your monthly premiums. Once you’ve reached your out-of-pocket maximum, your health plan will cover 100 percent of the costs associated with any additional medical services.
It’s important to look at the out-of-pocket maximum, as selecting the right one can help you avoid large medical bills in the event of a serious illness or injury.
Premiums are the monthly payments you make to your health insurance provider in exchange for access to their coverage. Premiums play an important role when it comes to choosing the right plan and can vary greatly depending on a variety of factors such as:
- Type of plan
Generally, plans with lower premiums have higher out-of-pocket costs and deductibles, while plans with higher premiums will cover more of your medical expenses without worry.
When it comes to choosing a health insurance plan, life events such as a new job, expecting a baby, and chronic illness can factor into health insurance costs.
For example, individuals with chronic illnesses may face higher premiums due to their pre-existing conditions. In the past, many insurers declined coverage for people with certain medical conditions. However, since the introduction of the Affordable Care Act, insurers are now required to provide coverage without regard for any pre-existing conditions.
Also, if you’ve recently taken on a new job, your employer may offer an insurance plan that’s more affordable than other options. You should compare plans and calculate out-of-pocket costs before selecting a plan to make the best decision for you and your family.
Lastly, if you’re expecting or planning for a baby soon, it’s important to consider plans that offer additional benefits, such as extensive maternity coverage or even free chiropractic exams. Although these plans may cost more in premiums, they can help ensure that most medical costs associated with having a baby are covered.
Tip 5: Compare Benefits
Once you’ve narrowed down your list of affordable health insurance plans, it’s important to compare the benefits they offer. When comparing benefits, ask yourself questions such as:
- Does the plan cover all or more of my regular medical care?
- Does the plan offer dental and vision coverage?
- Are there any additional benefits that I need, such as chiropractic or mental health services?
- What are the copayments for doctor’s visits and prescriptions, if any?
- Does the plan cover emergency room visits?
- What is the out-of-pocket maximum?
- Are preventive care services covered under the plan?
If you have any questions about selecting the best affordable health insurance plan, please don’t hesitate to speak with one of our representatives. They would be happy to help you figure out which plan is best suited for your needs and budget.
Selecting the right health plan for you and your family can be a daunting task. From comparing prices, networks, and benefits to understanding out-of-pocket costs and premiums, there are many factors to consider when selecting a plan that best fits your needs.
Redirect Health offers a comprehensive suite of benefits that sets it apart from the competition. For starters, we provide a 24/7/365 team of healthcare experts and providers who are available to answer any questions you may have about your plan benefits or medical concerns.
In addition, our plans feature some of the lowest out-of-pocket costs and premiums in the industry. With a wide network of over 700,000+ providers, you’re sure to find one that best fits your needs.
So, if you’re looking for an affordable health insurance plan, then visit RedirectHealth.com for a free quote today!