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  • Writer's pictureAhsan Malyk

What Health Insurance Should I Get in the US?

You usually have a short window of time to select the finest family health insurance plan, but hurrying and selecting the incorrect coverage might be expensive.


This step-by-step guide can help you locate cheap health insurance, whether it's through a state or federal marketplace, an employer, or another source.


Step 1: Decide which health insurance provider to use


Depending on your options, how you buy health insurance will vary.


If your company provides health coverage


An employer typically provides health insurance. You won't need to use government insurance exchanges or marketplaces if your job offers health insurance unless you want to shop for an alternative plan. But market-based programs will likely be more expensive than those provided by employers. This is so because most firms contribute to employee insurance premiums.


Should your company not provide health insurance


If your state offers one, shop there or on the federal marketplace to locate the best plan for you. Go to HealthCare.gov and start by entering your ZIP code. If your state has an exchange, it will be where you are sent. You'll use the federal marketplace otherwise.


Health insurance is also available directly from an insurer or through a private exchange. Premium tax credits, which are income-based savings on your monthly premiums, are unavailable if you select these choices.


Step 2: Examine various kinds of health insurance programs


You may run into some alphabet soup when looking for the most excellent health insurance option. The most popular health insurance plan types include HMOs, PPOs, EPOs, and POS. Your decision will influence your out-of-pocket expenses and the doctors you can see.


Online marketplaces typically offer a link to the summary of benefits, which details all the costs and coverages included in the plan. A provider directory that lists the medical facilities and offices that are a part of the network for the plan ought to be accessible as well. Request the benefit summary from your workplace benefits administrator if you are going through your employer.


Consider your family's medical needs


Take a look at the type and quantity of treatment you've previously received. Even though it's impossible to predict every medical expense, staying on top of trends can help you make a well-informed choice.


Examine your desire for a referral system for medical care.


Plans that demand recommendations


You typically need to see a primary care physician before scheduling a procedure or seeing a specialist if you choose an HMO or POS plan that demands referrals. Many people favor other plans as a result of this requirement. HMOs are typically the least expensive kind of health plan, but this is because you are restricted to using only the medical professionals they have partnered with.


One advantage of HMO and POS plans is that your entire medical care is managed by one primary doctor, which can lead to greater familiarity with your needs and continuity of medical records. If you use an out-of-network POS plan to lower out-of-pocket expenses, be sure to obtain your doctor's referral in advance. (With an HMO, you cannot leave the network unless there is an emergency.)


Programs that do not demand referrals


You might be happier with an EPO or PPO if you prefer to see specialists without a referral. (Most EPOs don't require a referral, but some do; be sure to read the small print.) If you can find providers who are in-network, which is more likely in a larger metro area, an EPO may help you keep costs down.


If you reside in a remote or rural area with little access to medical professionals and care, a PPO might be a better option for you as you might be required to go outside of the PPO's network.


What if an HDHP was combined with a health savings account?


The term "HSA-eligible" refers to health plans with high deductibles (HDHPs), which can be any of the four types of health insurance mentioned above (HMO, PPO, EPO, or POS). Although these HDHPs typically have lower premiums, you incur higher out-of-pocket expenses over time, particularly at first.


You can only open a health savings account, or HSA, which is a tax-advantaged account you can use to pay for medical expenses, if you have one of these plans. Make sure to first familiarise yourself with HSAs and HDHPs if you're interested in this arrangement.


Step 3: Evaluate network health plans


The medical centres and facilities that your health plan has agreements with to provide your care are referred to as part of your health insurance "network."


Why is the network relevant?


Because insurance companies bargain lower prices with in-network providers, costs are lower when you visit a doctor who is part of the network. When you visit a doctor who is not in your insurance's network, their fees are not pre-set, so you're usually responsible for a larger portion of the bill.


Have you got a favorite doctor?


Make sure they are listed in the provider directories for the plan you are thinking about if you want to continue seeing your current medical professionals. You can also directly enquire with your doctors to see if they accept a specific health plan.


Is having a large network necessary?


In order to give yourself more options, it's probably a good idea to look for a plan with a wide network if you don't have a preferred doctor. If you live in a rural area, having a larger network will be especially beneficial as it will increase your chances of finding a nearby physician who accepts your insurance.


If at all possible, get rid of any insurance policies that don't have nearby in-network medical professionals. You might also want to eliminate any policies that have a paltry selection of providers compared to other insurance policies.


Step 4: Contrast out-of-pocket expenses


Another important factor to consider is out-of-pocket expenses, which are not covered by your monthly premium. How much you'll have to pay out of pocket for services should be clearly stated in a plan's summary of benefits. The federal online marketplace and many state marketplaces provide comparable snapshots of these costs.


Familiarise yourself with the terms used in health insurance


Understanding the meanings of a few key terms used in health insurance is helpful.


  • Coinsurance: This is the portion of a medical bill (for example, 20%) that you are responsible for paying; your health insurance policy will cover the remaining costs.

  • The deductible is the sum you must pay out-of-pocket before your insurance will begin to cover your medical expenses.

  • Maximum out-of-pocket expense: This is the most you'll have to pay for covered medical care in a calendar year. Your insurance covers the remainder after you've reached this maximum.

  • Out-of-pocket expenses: These are any expenses you have to pay that are in addition to the premium for a plan, such as copays, coinsurance, and deductibles.

  • You pay a premium each month to maintain your health insurance policy.


In general, out-of-pocket expenses like copays and coinsurance decrease as your premium increases (and vice versa). A plan that covers more of your medical expenses but has higher monthly premiums might be preferable if:


  • You frequently visit a general practitioner or a specialist.

  • You often require emergency care.

  • You regularly consume pricey or name-brand medications.

  • You either have small children or are planning to have a baby.

  • Your scheduled surgery is soon.

  • You have been given a chronic illness diagnosis, such as cancer or diabetes.

  • fewer premiums, greater out-of-pocket costs

Step 5: Contrast advantages


By this point, your choices will probably have been reduced to several plans. Next, think about the following:


Examine the range of services.


Recheck that list of benefits to see if any of the plans offer a broader range of services. For things like physical therapy, fertility treatments, or mental health care, some people may have better coverage, whereas others may have better emergency coverage.


This simple but crucial step must not be skipped if you don't want to pass up a plan that would be much better for you and your family.


Resolve any unanswered questions.


You might find that the best way to get your questions answered is to call the plan's customer service number. Have a pen or electronic device to record the answers to your questions, which you should have written down beforehand.


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