Choosing health insurance is one of the most important choices you can make to protect yourself and your family. We know that it can be complicated, confusing, and difficult to understand.
Health insurance helps you pay for medical services and sometimes prescription drugs. You and your insurer each agree to pay a certain dollar amount or percentage of your medical expenses.
Health insurance premium is a fee to get and keep insurance. You may pay the whole premium. Or your employer may pay all or part of the premium. Usually, people pay premiums every month(1).
The cost of monthly premiums will vary for different people. It all depends on your age, where you live, your cost-sharing, and how many family members are covered under your policy. It will also depend on how much your share of the costs are. Generally. The higher your cost sharing (see below), the lower your monthly premium will be.
Types of Health Insurance Plans
Different types of plans help you get and pay for care differently. When purchasing health insurance, your choices typically fall into one of three categories:
Fee-For-Service (FFS) Medicare
Fee-for-service (FFS) is a traditional type of insurance. In which the health plan will either pay the medical provider directly or reimburse you after you have filed a claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice. This approach may be more expensive for you and require extra paperwork.
Traditional fee-for-service plans are usually the most expensive choice. However, they offer the most flexibility in choosing healthcare providers.
Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. So it generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Health maintenance organizations (HMOs) offer lower co-payments. Also, they cover the costs of more preventive care. Your choice of healthcare provider is limited to those who are part of the plan.
Preferred Provider Organization (PPO)
Preferred Provider Organization (PPO) is a type of plan that contracts with medical providers, such as hospitals and doctors. To create a network of participating providers. You pay less if you use providers that belong to the plan’s network. So You can use doctors, hospitals, and providers outside of the network for an additional cost.
Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more options when selecting a provider.
How to get the Cheapest Health Insurance Plan
Choosing a plan can be complicated. Knowing just a few things before you compare plans can make it simpler and cheaper.
- The 4 “metal” categories: There are 4 categories of plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
- Total costs for health care: You pay a monthly bill to your company (a “premium”). Even if you don’t use medical services that month. You pay out-of-pocket costs, including a deductible, when you get care. It’s important to think about both kinds of costs when shopping for a plan.
- Plan and network types — HMO, PPO, POS, and EPO: Some plan types allow you to use almost any doctor or healthcare facility. Others limit your choices or charge you more if you use providers outside their network.
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered? Guardian direct dental insurance review.
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
