Things to Look For in a Health Insurance Plan
Here are some things to look for when choosing a health insurance plan:
Cost: This includes your monthly premium, deductible, copays, and coinsurance. Premiums are the amount of money you pay each month for your plan. Deductibles are the amount of money you have to pay out of pocket before your insurance starts paying. Copays are fixed amounts you pay for certain services, such as a doctor’s visit or prescription drug. Coinsurance is a percentage of the cost of a covered service that you pay after you’ve met your deductible.
Coverage: Make sure the plan covers the services and providers you need. This includes your primary care doctor, specialists, hospitals, and prescription drugs. You can usually find this information in the insurance plan’s summary of benefits and coverage.
Network: A plan’s network is the group of doctors, hospitals, and other providers that the plan covers. If you see a provider outside of the network, you may have to pay more for services.
Type of plan: There are four main types of health insurance plans:
- Health maintenance organization (HMO): HMOs typically have the lowest premiums, but you have to see a doctor within the plan’s network and you may need a referral to see a specialist.
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- Preferred provider organization (PPO): PPOs have higher premiums than HMOs, but you can see any doctor or specialist you want, even if they are outside of the plan’s network.
- Exclusive provider organization (EPO): EPOs are similar to HMOs, but you may have to pay more if you see a doctor or specialist outside of the plan’s network.
- Point-of-service (POS): POS plans are a combination of HMOs and PPOs. You typically have to see a doctor within the plan’s network, but you may be able to see a doctor or specialist outside of the network for a higher cost.
- Other features: Some plans offer additional benefits, such as dental and vision coverage, wellness programs, and telehealth services. Consider which of these features are important to you when choosing a plan.
Once you’ve considered these factors, you can start comparing plans to find the best one for you. You can use the Health Insurance Marketplace, also known as Covered California, to compare plans and enroll in coverage.
Here are some additional tips for choosing a health insurance plan:
- Consider your health needs. If you have chronic health conditions or take prescription drugs, you’ll need to choose a plan that covers those services.
- Think about your budget. Health insurance can be expensive, so it’s important to choose a plan that fits your budget. Be sure to factor in the cost of premiums, deductibles, copays, and coinsurance.
- Read the fine print. Before you enroll in a plan, be sure to read the summary of benefits and coverage carefully. This will tell you exactly what the plan covers and how much you’ll have to pay for services.
- Ask questions. If you have any questions about a particular plan, don’t hesitate to contact the insurance company or a health insurance broker. They can help you understand the plan and choose the best one for your needs.