The task of choosing a healthcare plan for individual or family coverage should not be taken lightly. There are many factors to consider. Make a selection based on the answers to some pertinent questions.
What personal factors need consideration?
- Age of covered applicant(s)
- Current health status
- Family health history
- Current necessary medications
- Tobacco and alcohol use
- Typical medical needs
What are the plan options?
Healthcare insurance companies typically offer coverage under one of a variety of types of common plans. The options include:
- Health maintenance organizations or HMOs-The plan covers services provided by a specific network of providers and facilities. The plan offers the least degree of freedom in terms of choosing a healthcare provider. Individuals typically have a primary care provider who refers patients to specialists if needed. If an individual obtains treatment from a provider, not in the network, they do not receive compensation from the plan.
- Preferred provider organizations or PPOs-Plans offer more leeway in choosing a health care provider. But costs are higher for out-of-network care. Patients need not have a referral to see a specialist. Deductibles are higher when receiving care from out-of-network providers.
- Exclusive provider organizations or EPOs-Patients must see healthcare providers in the EPO network or forfeit coverage unless the event is an emergency. Specialist referrals are not necessary. Premiums are typically lower than PPO plans.
- Point-of-service plans or POS-The plans combine the features of HMOs and PPOs. Care must be provided by in-network health care professionals or incur higher fees. Out-of-network treatment requires payment by patients. Patients are reimbursed after submitting claims to the POS.
- High-deductible health plans or HDHPs-The plan may be any of the options mentioned above. However, individuals choose a higher deductible before the plan pays benefits. HDHPs may be connected to a savings plan to cover expenses not paid by the selected plan.
Which Healthcare Plan Category to Choose?
Each plan is usually available in different categories, which are as follows:
- Platinum plan covers 90 percent of medical costs leaving 10 percent for the patient.
- Gold plans cover 80 percent of costs, which leaves 20 percent.
- Silver plans cover 70 percent of costs.
- Bronze plans pay 60 percent of medical expenses.
- Catastrophic plans pay after patients meet the high deductible.