Selecting your family’s health insurance plan each year is one of the most significant financial decisions that you will make. The right coverage can open doors to quality care and positive health outcomes without causing financial hardships. The wrong plan can plunge you into debt with rising bills.
That’s why countless families rely on Bowthorpe & Associates Insurance Producers to help them review their options and choose coverage that meets their budget.
However, there’s more to it than comparing premiums. You also have to understand how plans work when you receive care.
In this article:
- Start With Your Family’s Real Health Needs
- Learn About Different Health Plans
- Don’t Focus on Premiums Alone
- Check Your Provider Networks
- Understand Prescription Drug Coverage
- Take Advantage of Financial Features
Start With Your Family’s Real Health Needs
No two families are alike. Some have very little contact with doctors and medical professionals. Others require frequent care, medications, or specialist appointments.
Review your family’s health care needs carefully before you start evaluating plans. Consider how often each person goes to the doctor and whether you’re taking any regular medications. Also think about any scheduled procedures for the upcoming year.
Your out-of-pocket costs can skyrocket with just a handful of specialist visits if you have to pay copays and coinsurance.
Remember to plan for the future too. Pregnancy, surgery, and chronic illnesses can drastically change your health care needs and associated costs. Think about what you might need later in the year to avoid selecting a seemingly affordable plan that leaves you with expensive bills down the road.
Learn About Different Health Plans
Not all health plans are created equal. The main categories of health insurance balance cost with flexibility in various ways:
- HMO : Low monthly premiums and savings on approved services, but you must stay in-network and get referrals to see specialists.
- PPO : Higher monthly cost, but see providers without a referral and have the option to go out-of-network for care.
- EPO : A cross between HMO and PPO plans. No referrals required, but you must stay in-network for care.
- POS : Provide more flexibility when you get referrals from your in-network primary care doctor.
Consider how important access and flexibility is to your family when looking at plans. If you already have doctors you love, double-check they are included in the plan before enrolling.
Don’t Focus on Premiums Alone
When comparing plans, many families get caught up in monthly premiums. However, this is just one piece of the total cost puzzle.
Review the plans deductibles, copays, coinsurance amounts, and out of pocket maximum. Once you understand each of these factors you can roughly calculate what you will pay for the entire year.
Some plans with lower monthly premiums will have higher deductibles. That means you will pay more before your coverage starts kicking in to help. Plans with higher monthly premiums may lower your total out of pocket expenses when you need care.
Try to view your healthcare costs from a yearly perspective, rather than focusing on the price of monthly premiums.
Check Your Provider Networks
Even if you find the perfect plan at the best price, it doesn’t matter if you can’t access the care you need.
Double check that your current primary care doctor, pediatrician, and specialists are all in network before enrolling. Switching providers can be a frustrating and time consuming process, so this review could save you a lot of headache down the road.
Take a moment to understand how the plan covers urgent care, telehealth, and emergency visits as well. Having access to quality care when you need it is important – especially if you have young children.
Understand Prescription Drug Coverage
Prescription coverage is one of the most overlooked aspects of health insurance, but it can also be one of the most costly.
Every health plan has a formulary, which is a list of covered drugs. Medications are placed into tiers that determine your cost.
If there is someone in your family that takes regular medications make sure the drugs they need are covered and affordable under the plan. You should also check for prior authorization requirements or refill limitations that could impact access if you’re not careful.
Take Advantage of Financial Features
Depending on the type of health plan you choose, you may have access to accounts that help you pay for care.
Health Savings Accounts let you contribute pretax dollars into a special account for qualified medical expenses. They are only available with certain high deductible health plans. Flexible Spending Accounts are another option that allow you to set aside money to pay for expected medical costs.
Both of these options can be beneficial to your overall financial strategy when utilized properly.
Make the Right Decision For You and Your Family
Health insurance doesn’t have to be complicated. As long as you take the time to understand your family’s needs and evaluate your options carefully you should be able to make an informed decision.
Remember, there is no one “best” plan. Your ideal coverage will depend on your family’s unique health needs, financial situation, and desired flexibility.
Consider working with Bowthorpe & Associates Insurance Producers to review your options and avoid costly enrollment mistakes. A smart decision now can protect you and your family from health issues and financial stress down the road.
Frequently Asked Questions
How do I select the best health insurance plan for my family?
Evaluate your family’s health needs, preferred doctors, and anticipated health care usage. Then compare overall yearly costs between plans instead of just looking at monthly premiums. Ensure your doctors and providers are in network before enrolling.
What is the difference between an HMO and PPO health plan?
HMO plans require you to seek care from providers within their network and get referrals to see specialists. PPO plans allow more flexibility to seek out-of-network care for a higher cost.
What should I review before enrolling in a health plan?
Look over doctor networks, drug coverage, deductible costs, out of pocket maximums, and whether you’ll need referrals for specialist care. Each of these can impact both your access to care and your overall costs.
Are high deductible plans a good choice for families?
If your family is healthy and you want to save on monthly premiums while opening up a Health Savings Account, then a high deductible health plan could be a great option. However, you may pay more out-of-pocket for care when you need it.
When is open enrollment for health insurance plans?
Open enrollment occurs once a year for health insurance, but you can also qualify to enroll outside of that period if you experience certain life events. Life events that trigger open enrollment for you and your family include marriage, childbirth, and losing other coverage.