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How to Find the Best Health Plan for You

Health insurance is essential, but with so many insurance options, it isn’t always easy to find the policy that is best suited to the needs of you and your family. You may start a conversation with an insurance agent expecting to get only a bare-bones policy, and discover that you may need additional coverage for vision, dental or critical illness.  What may surprise you even more is that you may be able to get a comprehensive health plan that covers almost all of your possible medical problems for only a few dollars a month.

Consult with Your Physician

Before you start your search for the ideal health insurance plan, you may wish to call your doctor first, especially if you plan to keep visiting him or her. Ask which insurers they take as well as what kind of network they operate on.  If you get a policy that doesn’t include your physician in their network, you may have to pay hefty out-of-pocket fees to see them or switch to another in-network provider.

Also take some time to discuss your current and future medical conditions.  Although insurers can no longer turn you away for having a pre-existing condition, they may not include all of the coverage you need. Ask your doctor what is the likelihood you may get cancer or have a heart attack. Your doctor may identify risk factors like smoking or obesity which raises the risk of major health issues.  Furthermore, be frank about members of your family who experienced major health conditions since some of these may be genetic.

If you are at risk for one or more of these health conditions, then ask your insurance agent about a critical illness policy. These supplemental health plans are wise investments for people at risk for serious health issues because they offer additional financial protection if such a condition should arise.  For example, some cancer therapies cost more than $30,000 a month which can quickly sap a conventional health plan.  However, with a critical illness policy for cancer, you have additional resources to pay for lifesaving treatments for just a few dollars a month.

Analyze Your Finances

It is in your best interest to sit down and examine your finances in detail before you start shopping for a health plan. You should know how much money you can spend on monthly premiums and out-of-pocket expenses as well as your total annual income to determine if you qualify for an Obamacare government subsidy.  Then you can intelligently discuss your options with a Boost Health Insurance Agent.

If you meet certain income requirements, your agent may suggest that you consider a policy from one of the Affordable Care Act-sponsored health insurance exchanges.  For many households, these federally subsidized plans are perfect because they provide basic health services as well as catastrophic coverage at a severely discounted price.  There are many types of policies, classified as Bronze, Silver, Gold or Platinum, but keep in mind that some of the less expensive plans may have high deductibles. The plans for 2016 had out-of-pocket maximums as high as $6,850 for individuals, or $13,700 for families.

If you are chronically ill, then there may be better options for you than a high deductible ACA plan.  Many of these policies may not be as inexpensive as those found on the exchanges, but they may provide advantages like lower out-of-pocket maximums, more access to providers and network inclusion of your doctor. That way, if you visit a physician often, you are likely to pay less for each visit.

Choosing the Right Network

As you discuss health plans with your insurance agent, he may throw out some terms like HMO, EPO, PPO or POS.  If you aren’t familiar with these terms, you should know that they define your provider network. Keep in mind the following definitions during any insurance consultation:

  • HMO plans are typically the least expensive, but they offer the most restrictive networks.  You must have a primary care physician that makes referrals before you may see a specialist. An HMO plan will also not reimburse you if you see an out-of-network provider. 
  • PPO plans are a bit more expensive, but you may see specialist without a referral (although you may need pre-authorization from your insurer).  These types of plans often will pay in full or in part, the cost of visiting a provider not in your network.
  • EPO plans offer some of the flexibility of a PPO plan while limiting your out-of-network access.  You may see a specialist without a referral but there is no reimbursement for out-of-network visits.
  • POS plans are the reverse hybrid of EPO’s. You must have a primary care doctor that refers you to specialists, but there is out-of-network reimbursement—as long as you have a referral.

If you are committed to your current physician, then you should ask your insurance agent if they are included in any prospective plan.  If not, you may wish to consider a broader plan that will enable you to keep making visits.

If you are someone who is away from home often, you should also consider a broad plan that allows you to see providers outside of the networks.  For many people who travel, this allows them more coverage on trips.  However, you should keep in mind that even PPO plans may require you to make additional out-of-pocket payments for non-network doctors.  It is also important to note that the broader the plan, the more expensive the monthly premiums are likely to be.

It may take some time to find the right health plan for you and your family, but you will find it eventually. Just take the time to understand your health situation, your finances and the components of a health insurance policy.  If you are still unsure what health plan best satisfies your needs, you can often find the answer from an experienced insurance agent, like those found at Boost Health Insurance.

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