In this economy, many people have lost their jobs or are in fear of losing them. Retirement savings are down and no one seems to know when the economy will turn around. In times like these we must pay close attention to how every dollar is spent. If you’ve lost your health insurance or otherwise need to get health insurance, it’s more important than ever to get the coverage you need to protect your family’s finances without paying for coverage you don’t need.
PPO, HMO, HSA…with so many health insurance plans to choose from, how do you know which health plan is right for you? With hundreds of health plans available it can be difficult to decide which health plan is best for you and your family.
The following guidelines are provided by Jeff Breazile, owner of Benefit Studio Health Insurance Services (http://www.benefitstudio.com), a California based independent insurance agency.
To help narrow down the many choices available and find the right plan for you and your budget, it’s important to compare premium quotes from different health plans. But what benefits do you get for your monthly premium? Look beyond just the quoted premium of a health plan and consider what benefits in a health insurance plan are most important to you.
Focusing on the benefits you need most is the first step in finding a Califorrnia health insurance plan that not only offers the protection you need, but is affordable as well. The health plan with the lowest premium may not give you the financial protection you need if you get sick, have an accident or otherwise need to seek medical attention. A comprehensive health plan that covers a wide range of services and benefits may cost more in premium, but could actually save you money over a basic or “catastrophic” plan on the other end of the spectrum where you would pay a much larger share of the costs when you receive medical care.
Here are some tips to help you narrow down the list of health insurance plans when deciding which plan will be the best fit. Start by deciding which type of benefits are most important to you. What benefits have you used most in the past? How much of the medical expenses could you reasonably pay yourself if you have a major medical event? Use the following list to focus on the most important benefits. Then you can compare the plans with the benefits that best fit your needs.
PPO or HMO plan maternity benefits deductible amount copayment (copay) coinsurance amount out of pocket maximum prescription drug coverage (generic + brand name benefits or generic-only) preventive care services health savings account (HSA) compatible health plan
PPO - Is it important to you that your plan offer a large network of participating doctors and hospitals? Do you want to be able to see a specialist without having to obtain a referral from your primary doctor? Preferred Provider Plans (PPO) offer the largest networks of participating doctors and hospitals. With a PPO you also have the option of getting medical care outside of your PPO network, although you will usually pay more if you receive care from a provider that is not in your network.
HMO - Another option is a Health Maintenance Organization (HMO). Although not as popular as PPO health plans, many people prefer them due to their simplicity. You can obtain most services for a low copayment and usually no coinsurance requirement. The tradeoff with an HMO is you must stay in network to receive covered medical services. HMO networks are normally smaller than PPO networks and generally a referral is required from your primary care doctor to see a specialist.
Maternity Benefits - While the cost of health insurance plans vary widely, and it’s important to choose a health plan that has the benefits you need, you may be able to save money by choosing a plan without certain benefits. If maternity benefits are not important to you, look for a health plan without maternity benefits. This alone could save you hundreds of dollars annually on your health insurance plan.
Deductible Amount - Except for services where you are only responsible for a copayment, the deductible is the amount you pay before the insurance plan pays anything. If you’re willing to pay more of the upfront costs when you need medical care, choosing a higher deductible can help keep your insurance premiums lower.
Copayment (Copay) - The copay is a flat fee you pay at the time of service. After paying the copayment, the plan usually pays 100 percent of the balance of covered services. Some California health insurance plans allow you to visit the doctor’s office for a low copay without having to meet your annual insurance deductible.
Coinsurance - In addition to the deductible, when comparing health insurance plans, pay attention to what coinsurance amount you will be responsible for after your deductible is met. Coinsurance is the percentage of the charges you are responsible to pay for covered medical services apart from any copays or your deductible.
Out of Pocket Maximum - The out of pocket maximum is the maximum amount per year you’ll have to pay for covered medical services. After reaching your out of pocket maximum, your health insurance plan pays for any additional covered medical expenses up to the plan’s lifetime benefit amount.
Prescription Drug Coverage - When it comes to prescription drug coverage, some health insurance plans keep the premiums lower by covering only generic prescription drugs. Keep in mind that while there are many generic prescription drugs available, not every prescription drug is available in generic form.
Preventive Care Services - In order to encourage healthy lifestyle habits and thereby reduce future medical expenses, many California health insurance plans offer low or no copayments or other financial incentives for preventive care services such as physical exams, immunizations, annual gynecological exams, mammograms, prostate exams and cancer screenings.
Health Savings Account (HSA) - Are you interested in a health plan that will help you save money on your tax bill? Consider a Health Savings Account (HSA) compatible health plan. A Health Savings Account (HSA) combines high deductible health insurance with a tax-advantaged medical savings account. Withdrawals that are used to pay for qualified medical expenses, including your insurance deductible, coinsurance and co-payments are federally tax-free.
By focusing on these nine plan benefits when shopping for California health insurance, you’ll find a plan that fits your healthcare needs and your pocketbook.