5 Tips For Choosing a Health Insurance Plan

Open enrollment (the annual period where you can enroll in major medical health insurance plans), begins November 1, 2020 and will remain open for 45 days, or until December 15. For someone looking to change or add coverage, this offers a short window of time to decide on and select your health insurance plan. Before rushing a decision to meet this deadline, take some time now to review and prepare. Below we’ve rounded up our top tips for choosing the right health insurance plan for you and your family’s needs. 

Who Should Utilize Open Enrollment?

The Open Enrollment Period (or OEP) is for anyone looking to make a change to their health insurance coverage, whether through their workplace or the federal market. This could include looking for a cheaper plan with similar coverage, gaining coverage if you previously had none or changing your coverage altogether to better meet your needs.

Tip #1: Asses Your Current Costs 

When thinking about changing your health insurance plan, it’s important to reassess your healthcare-related expenses. Take a look at how much you’re currently paying per month for your plan as well as what sort of out-of-pocket expenses you paid over the past 12 months. 

These could include:

• Routine doctor’s visits
• Specialist visits
• Prescriptions
• Emergency room or urgent care visits

Unless you foresee any major changes in the coming year (such as pregnancy), this could be a helpful indicator when it comes to determining what type of coverage will be cost-effective and appropriate for you.

If you found your out-of-pocket expenses to be too high, now’s your opportunity to search for a plan with lower deductibles (although your monthly premiums will likely rise).

Tip #2: Choose Your Marketplace

You’ll may be able to gain coverage through several marketplaces including:

• Your or your spouse’s workplace
• Federal marketplace
• Local or state marketplace
• Private exchange
• Directly through insurance providers

If you have the option to gain coverage through your employer, this will likely provide you with the lowest premiums. That’s because your employer pays a portion of the premium, which tends to be lower anyway.

If your employer does not provide healthcare coverage (or you wish to look elsewhere for it), you can gain coverage through the federal or state marketplace. You’ll start at Healthcare.gov, which will then direct you to your state’s marketplace (if applicable). While premiums are likely to be higher, you may be eligible for premium tax credits to help offset the monthly cost.

Tip #3: Decipher Your Available Plan Types

There are four common types of health insurance plans you’ll come across when selecting coverage: HMO, PPO, POS, EPO. All health plans involve tradeoffs among cost, coverage, and convenience. Cost considerations include not only the monthly premiums but also deductibles, copays, and out-of-pocket maximums. Less expensive plans usually come with more restrictions on the breadth of health care providers (physicians) included in the plan. Often, the best providers accept only more expensive insurance plans. Also, cheaper plans may make it more difficult or expensive for you to see a specialist provider by requiring a referral or making you pay more for an out-of-network provider.

Health Maintenance Organization (HMO)

Pros: HMOs tend to have lower monthly premium costs and out-of-pocket costs as compared to other plan types. 

Cons: You’re typically limited to seeing providers only in your network, and these must be coordinated by your primary care provider (unless it’s an emergency). This gives you less overall flexibility.

Preferred Provider Organization (PPO)

Pros: PPOs offer the user more freedom than an HMO when it comes to choosing healthcare providers and specialists. You can see people outside of your coverage network, although this will typically result in higher out-of-pocket costs. Additionally, you typically will not need a referral from your primary care provider to make appointments with specialists.

Cons: Out-of-pocket costs and premiums tend to be higher for PPO plans when compared to an HMO.

Point of Service Plan (POS)

Pros: With a POS plan, you have the flexibility to visit out-of-network healthcare providers, but typically at a high out-of-pocket cost.

Cons: Similar to an HMO, you will likely need a referral from your primary care provider to see a specialist or have a medical procedure done. Additionally, your primary doctor will coordinate your care for you.

Exclusive Provider Organization (EPO)

Pros: An EPO will typically offer you lower out-of-pocket costs than a PPO or POS plan, and a referral is not needed to see specialists or have medical procedures done.

Cons: You will be required to visit specialists within your network, unless it is an emergency. An EPO will typically provide less flexibility and freedom when it comes to choosing care providers.

Tip #4: Consider a Plan with an HSA

If you are in good health and do not expect to have large health care bills in the coming year, you might do well to consider a “High Deductible Health Plan” that would allow you to open a Health Savings Account. An HSA can be used either to pay immediate health care expenses, or as a kind of medical IRA to build up tax-free savings over the long run for future medical bills, perhaps in retirement. The option to invest tax-free for the long-term makes an HSA particularly attractive for younger people (who also are typically healthier). In 2021, an HDHP must have a minimum deductible of $1,400 for an individual or $2,800 for a family. As with an IRA, there are limits to the amount of money you can contribute to an HSA during the year. For 2021, the contribution limit is $3600 for an individual and $7200 for a family.¹ Get more details about HSAs here.

While HDHPs tend to have very low monthly premiums, the downside is the relatively large deductibles and the high out-of-pocket costs compared to other types of plans.

Tip #5: Account For Your Current Providers

As shown above, every plan type either requires you visit in-network providers or offers lower out-of-pocket costs for visiting an in-network specialist. If you already have established relationships physicians that you like on your current plan, switching plans could jeopardize your ability to visit them in the future (or cost you more to do so). 

When comparing plans, make sure to check whether or not your current healthcare providers are in-network. If they are, you should have no problem continuing to see them as you did before. If they’re out-of-network, you’ll either have to find a new provider or prepare to pay more for every visit.

Picking the right health insurance plan for you and your family can feel daunting, confusing and rushed. With some time left before open enrollment, do yourself a favor and create your plan of action now. Reduce the stress and headaches by understanding what type of plan may be right for you, what coverage you know you’ll need and determine what marketplace you’ll be buying from. When November hits, you’ll be more than ready to make a decision that’s right for your healthcare needs.