5 Things to Know Before Choosing a Healthcare Plan

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Our health is the most important thing in our lives, and we should all make it a priority to focus on our health. Putting our health first looks different around the world: in Australia, patients with Medicare can schedule visits with bulk billing doctors who accept Medicare benefits as full payment for medical procedures. Patients in Britain feed their taxes into a state funded system called the NHS, or National Health Service which guarantees healthcare for everyone.

In the U.S., citizens have to buy (expensive) insurance. They pay a premium each month and the insurance company then pays part of the medical bill. Citizens are still left with bills, though. Honestly, in my opinion, it’s a terrible healthcare system that oppresses people with low socioeconomic status and often people of color.

Because Americans have to pay for insurance (and not all insurance is the same), it is essential to choose the right healthcare plan to ensure the best medical assistance. Below are five important things to know before you choose a healthcare plan, whether it’s for you, or your family. There’s a lot of things you want to keep an eye out for when comparing insurance plans.

Premiums

Most people in America with health insurance have insurance provided by work, their spouse, or their parents. However, there are healthcare insurance plans you can pay for as a third-party for more or less (price, coverage, & hassle), if you don’t like the plan offered to you.

It’s important to know what you’re getting into if you go this route. Insurance policies can be incredibly dense and convoluted. If you’ve ever talked to anyone about insurance plans, you’ve probably heard the term “premium.”

A premium is the price you pay each month for your insurance plan. When you have insurance through your employer, they pay for most, if not your entire, premium. Some people might say to look for a lower premium – but this can cost you in the long run if you aren’t careful. You want to take all facets below into consideration when determining if the premium of your chosen insurance plan fits into your budget.

Coverage

Good healthcare insurance coverage is typically more expensive than average provider plans. However, they are worth the added benefits and wellness programs. You might not actually need a plan with a ton of coverage if you aren’t a frequent patient – but it is worth considering for emergencies.

UnitedHealthcare Insurance, for example, offers a variety of health insurance plans with a high deductible (a specific amount of money you have to pay toward your medical bills before insurance starts paying; more on this below) up front, but a lot of coverage down the road. There’s a difference between a healthcare plan that will 100% cover a fully loaded surgery versus a healthcare plan that will cover only half or 25%.

A healthcare plan with good coverage might cost you a lot up front, but it can save you from debt in the long run.

Deductibles & Copays

Even with health insurance, there will be certain out of pocket costs.

Before your insurance coverage kicks in – you are responsible for paying a deductible. Your deductible is a certain amount of money you pay out of pocket before your insurance plan starts to pay for services. A $2,000 deductible will initially pay for $2,000 worth of covered services, and after that you will have a copayment for your services.

If you visit the doctor, the dentist, a therapist, etc. you might be expected to pay a $10-$50 (sometimes more) copayment for the service. After that, depending on your healthcare coverage, whatever services you have done will be covered by your insurance plan.

PPO vs. HMO

There’s a variety of healthcare plans to choose from when making the decision.

EPO– An Exclusive Provider Organization plan offers a local network of doctors and hospitals under their coverage. Out of pocket costs are typically moderate compared to the other plans, and the premiums can be lower. However, you can’t stray outside of your plan’s network.

HMO– A Health Maintenance Organization plan offers a local selection of doctors and hospitals to choose from. With lower premiums, an HMO might work for you if you aren’t interested in a flexible plan.

PPO– A Preferred Provider Organization plan offers a large network of doctors and hospitals to choose from. With higher premiums and deductibles, this might be a good option for you if you want total flexibility over your healthcare options. When purchasing health insurance, I always go with a PPO. It’s more expensive, but it’s a great benefit to be able to see (almost) any doctor you want.

Enrollment

Now that you have an idea of what insurance plan you want, what’s covered, and how much you have budgeted for – it’s time to enroll. This process is going to look different based on where you are located.

First, visit HealthCare.gov to determine when open enrollment begins at the Health Insurance Marketplace. There are dates, deadlines, and paperwork that you need to pay special attention to. Again, it varies depending on your state, so make sure you have the correct info!

If you’re in the U.S., good luck finding your health insurance plan – I hope it goes well!

Thank you for reading!