It is the season to get out of your comfort zone, gather everything you need and pick a health insurance plan for 2021. If you are shopping for a new plan, open enrollment starts November 1 and ends December 15. Whether you are researching the Affordable Care Act plans on healthcare.gov or comparing individual healthcare plans, there are a lot of factors you need to consider.
Keep in mind that whatever plan you choose during the open enrollment period will be your healthcare insurance plan for the whole of 2021 unless you experience life qualifying events such as marriage or birth of a child.
It means you need to take time and choose your healthcare plan wisely. We understand the fact that healthcare can be quite tricky even for experts. That is why we’ve gathered a few tips to help you choose the right plan for you and your loved ones.
1. Identify Your Needs
Before you start shopping around for plans, you need to identify your needs and know exactly what you want. What is important to you and your loved ones? Some of the crucial questions you need to answer include:
- Do you want to keep your medical costs as low as possible?
- Are you happy with being restricted to a specific group of doctors and having your medical care authorized by a designated primary care doctor?
- Are you willing to pay a higher premium to access specialists directly without any authorization?
- Are there any specific treatments or healthcare services you need the health insurance plan to cover?
- Do you or your family member wish to see any specific doctors, and are those doctors available under the health insurance plan you are considering?
- Do you have a loved one who regularly uses prescription drugs and are the specific drugs you need covered under the plan you are considering?
Once you have answered all these questions, you will know exactly what to look for in a health insurance plan. You will start shopping around knowing your needs which makes it easy to spot a perfect plan that suits you and your family.
2. Understand Your Options
When it comes to choosing a healthcare plan, there is nothing like a one-size-fits-all plan. Whether you are selecting a plan for the first time or evaluating how well your current plan has met your needs, you need to take time and compare the benefits, costs, and services of each plan to establish what works best for you.
The first thing you need to do is ensure you understand the health insurance lingo such as deductible, premium, out-of-pocket maximum, and coinsurance. Don’t be afraid to Google terms you don’t understand.
If you are on Medicare age, ensure you are familiar with the difference between Original Medicare and Medicare Advantage. Some crucial things, such as dental, hearing, and vision care, are not covered under Original Medicare.
3. Understand How Different Plan Types Work
There are different types of health plans that work differently. They include
a) Health Maintenance Organizations (HMOs)
HMOs usually limit covered services to specific hospitals and doctors. Consultation with specialists must also be authorized in advance by your primary care doctor. However, HMOs have relatively lower premiums costs and out-of-pocket costs compared to other plans.
b) Preferred Provider Organization (PPO)
This type of health insurance plan allows you to direct your own care and decide where you want to get services. You are also not required to obtain authorization to consult specialists, but it is good to ensure the plan pre-certifies some services such as surgeries.
If you use the plan’s in-network doctors, you pay much less compared to when you use other providers who are contracted by the plan provider.
c) PPO with Health Savings Account
The HSA plan can be funded by the employer or employee up to certain IRS limits and can help cover your deductible and pay for certain eligible expenses. But you pay out-of-pocket or from HSA until you meet the deductible.
You may see any physician you like but choosing an in-network doctor helps to keep your costs lower.
d) Exclusive Provider Organizations (EPO)
An EPO plan will typically offer you relatively lower out-of-pocket costs, and you don’t need a referral from your primary care doctor to see a specialist or have some medical procedures done.
But you will mostly be required to seek specialist assistance from the specialists within your network unless it is an emergency. An EPO is less flexible and doesn’t give you freedom when it comes to choosing care providers.
4. Review Other Plan Options Even If You Like Your Current One
Even if you are already enrolled in an ACA plan, and you are happy with your current provider, you still need to log in and check if there is an option offering better value for money. Many websites gather healthcare data and conduct in-depth policy analysis that can help you make an informed decision.
Sometimes, you may be tempted to skip the entire enrollment rigmarole because you are happy with your current provider only for things to change later. Keep in mind that there is nothing you can do after the open enrollment period.
Every year, there can be different changes that affect different plans and their costs. For instance, this year, some new health insurance providers have entered the marketplace bringing down premiums in some states.
It is always worth logging in and comparing different plans with what you currently have to see if it makes sense to make a switch.
5. Consider Out-of-Pocket Costs
Your out-of-pocket payment refers to the amount of money you should expect to pay for certain services under your health insurance plan. With HMOs, you are expected to pay set co-payments while PPOs are subject to annual deductibles and coinsurance for most healthcare services.
There may also be a few services under HMO that you will be expected to pay a coinsurance. The good news is that some preventive care services are provided free of charge.
Health plans also have an annual maximum out-of-pocket amount which most people overlook. A plan’s out-of-pocket maximum is meant to protect you from paying a high amount of money out of your pocket for healthcare services.
6. Consider a Plan That Offers Telehealth and Virtual Visits
If you are busy with work schedules, juggling kids’ schedule or simply enjoy the convenience of doing things from home, you should consider choosing a health insurance plan that includes 24/7 visits.
Such plans are designed to be an easier, affordable, and convenient way to talk to a doctor about some of the common health issues. In such a case, all you need is a smartphone or PC and internet connection.
Telehealth services are mostly available to members of employer-sponsored, individual and the Medicare Advantage plans.
7. Get Help from the Experts
Even though the Trump administration slashed federal funding for advertising open enrollment, there are a few people across the country trained and ready to sign you up- for free. So, if you are not familiar with health insurance, be sure to get expert help.
You can meet in-person with a certified application counselor or health insurance navigator and explain your needs to him/her. These experts are impartial and will offer you the best advice.
Talk to Us Today for Professional Assistance
At Insurance Master, we are dedicated to helping you find the best and most affordable health insurance plan that will suit your needs. We have a team of experienced and licensed insurance agents ready to help you make an informed decision.
Contact us today and let us help you find an ideal health plan during the open enrollment period.