If you live in the United States, having health insurance is an absolute must. Without it, the cost of even the minutest medical care – like having a doctor examine a scrap, cleaning it up, and bandaging it – can cost you an excessive amount of money.
While being insured is a no-brainer, picking out a plan is anything but simple. There are a lot of factors that need to be taken into consideration; and like most people, top on your list of priorities is the cost. While insurance does help to reduce the out-of-pocket expense of your health care, the cost of health insurance itself can be exorbitant. When your budget is stretched thin, monthly premiums, deductibles, and co-pays can really take a toll. That’s why price tags are usually the most important factor that Americans take into consideration when they’re selecting a plan.
While you don’t want to spend a fortune on your coverage, price shouldn’t be the only thing you look at when you’re shopping for health insurance. Cheap doesn’t necessarily mean better; in fact, if the price of a plan seems too good to be true, more than likely, it probably is. Sure, you might be paying an affordable rate, but if your policy doesn’t offer the coverage you need, it really isn’t going to save you much money in the long run.
So, besides price, what other factors should you be considering when you’re comparing health insurance plans and their rates? Here’s a look at some of the top factors that you’re going to want to weigh when you’re shopping for health insurance.
As the name suggests, “covered benefits” refers to the services that a policy covers; things like routine health examinations, diagnostic testing, emergency room visits, and hospital stays, for example. Each policy lists the benefits it covers, and it’s really important that you examine those benefits closely.
Just because a policy has an attractive price tag, that doesn’t necessarily mean it’s going to cover the services that you need. Under the Affordable Care Act (ACA), health insurance plans must provide at least 10 essential health benefits. These benefits include things like visits to the doctor, inpatient and outpatient care in a hospital setting, prenatal care, childbirth, and even mental health services. However, while there are several benefits that insurance plans must cover, they aren’t required to cover every benefit; and what happens if a benefit you need isn’t covered? For example, the plan you’re considering may not offer dental benefits. Considering the fact that dental health is exceedingly important, having access to dental health coverage is vital. Therefore, if the plan you are considering doesn’t include dental care as a covered benefit, you’ll have to purchase additional coverage.
Make sure you read through the details to find out exactly what services a health insurance plan covers, and what services it excludes. If you don’t, you may think you’re covered for a specific service and find out you aren’t when you get an unexpected (and costly) bill in the mail.
Most health insurance policies have networks that are comprised of healthcare providers that work with the insurer. These healthcare professionals are considered “in-network”. If you see someone who is “out of network”, you could end up paying a hefty sum. Why? Because, depending on the type of insurance plan you have, visits to out of network doctors may not be covered at all.
While some plans do provide coverage for out of network visits, it costs less to see someone in-network; therefore, if you do see a doctor who doesn’t participate in your plan, while your plan may cover the visit, it will cover less of the cost; that means higher out-of-pocket expenses for you.
When you’re looking at the network of healthcare professionals a plan lists, pay close attention. If you have specific doctors that you have a history with and they aren’t in-network, look for a plan that your doctors do participate in; otherwise, you’ll end up paying the difference.
Coverage for Prescription Medications
This is especially important if you rely on medications on a regular basis; however, it’s just as important if you don’t take regular medications because you never know when you’re going to come down with an illness that requires a prescription.
Make sure that the plan you choose offers coverage for prescription drugs, and examine the type of medications that it covers. If you take a specific type of medications – insulin, for example- it’s important that you make sure the policy provides coverage for the type that you take (or an acceptable substitute). If the plan doesn’t cover your medications, you’ll have to pay the full price yourself; considering the cost of full-price prescription drugs, that could really end up eating into your budget.
Of course, it goes without saying that when you’re comparing the rates of health insurance, cost is going to be high on your list of priorities. Make sure you have a firm understanding of what the out-of-pocket expenses are for the plans you’re considering.
Out-of-pocket expenses are attached to most health insurance policies, and as the insured, you’re responsible for paying those expenses. Costs to consider include deductibles (the amount you’ll have to pay before your health insurance kicks in), co-pays (a flat fee for a specific services, such as a $20 charge each time you see a doctor), and coinsurance (a specific percentage of the final cost of the care you receive).
For obvious reasons, knowing the amount you’ll be responsible for covering is pretty important.
Summing It Up
It’s not enough to have health insurance; you need to make sure that you have a plan that meets all of your needs. When you’re shopping around, make sure that you consider all of the above-mentioned factors before you sign on the dotted line; otherwise, it may end up being as if you don’t have insurance at all, even though you do!
If you need help weighing the options, consult with a reputable insurance agent.