Your Guide to Health Insurance
Many unique needs. One Price & Ramey.
Navigating the complex world of health insurance can often be overwhelming and confusing. If you don’t receive a health insurance plan through your employer, you are often on your own to find a provider and a plan that works for you and your family. Even if you select a plan, are you confident it is the best coverage for your budget and healthcare needs?
When considering health insurance, there are a few basic concepts you should understand to help you make sense of what you are getting from different types of plans.
1. Types of Coverage
Typical health insurance plans consist of:
- Short-Term and Long-Term
- Medicare and Medicaid
These plans are often bundled together, but it is important to understand that your medical health insurance plan will not cover all medical expenses. There are additional plans for other unique coverage if you have a unique need.
2. Types of Health Insurance Plans
One of the most confusing aspects of health insurance is understanding the various types of plans. They are often referred to as their initialism, which can make it difficult to know what coverage limitations you may be signing up for.
Health Maintenance Organizations (HMOs)
An HMO will create a network of local medical experts to choose your care from and are typically less expensive as long as you stay in-network. These plans have you establish a primary care provider who you must see for referrals to specialists.
Exclusive Provider Organizations (EPOs)
An EPO will similarly create a network of local medical experts to choose your care from, and in-network specialists do not require a referral from a primary care provider. Though, they will not cover any expenses if you receive care out-of-network– except in the case of an emergency.
Point-of-Service Plans (POSs)
A POS also creates a network of local medical experts to choose your care from and requires you to choose a primary care provider. Specialists still require a referral, though you can choose an out-of-network specialist if you are willing to pay higher costs. With this plan, you may be required to get pre-authorization for medical procedures.
Preferred Provider Organizations (PPOs)
A PPO will offer you the largest network of medical experts to choose your care from, you are not required to have a primary care provider and you can see specialists without referrals.
3. Legal Coverage Requirements
The Affordable Care Act requires all U.S. citizens to obtain health insurance.
Not all businesses are required to offer health insurance, and cost-effective plans are available to those who do not have provided health insurance. If you are a business owner looking for group health plans, please view our Employee Benefits resources here.
4. Common Health Insurance Terms
Understanding insurance can be tricky. Here are a few common definitions to help.
In vs. Out of Network: Your health insurance policy will identify providers who they cover expenses with. Ensure your selected primary care and specialists are in-network to avoid higher costs.
Copay: Your insurance policy will include costs on top of your deductible, including a copay. A flat fee that you pay on top of your premium each time you visit a physician or fill a prescription.
Coinsurance: After you have paid your deductible for the year, this is the amount of medical cost you share with your insurance company, before you meet your out-of-pocket. Look closely at your policy to see at what expense tier this begins, and what percentage of the expense will you be responsible for.
Out-of-Pocket Maximum: This is the absolute most you could pay in medical expenses in a given year under your specific policy, if you incur more expenses than your out-of-pocket maximum, your health insurance will cover the remaining expenses.
Claim: A formal request for an insurance company to cover a particular incident under a policy.
Premium: This is the amount you pay for your insurance policy, whether you pay monthly, once a year or every six months.
Deductible: This is the amount that you pay out of pocket for a claim. Policies with lower premiums often include higher deductibles and vice versa.
5. Knowing How to Navigate
Even with research and guidance, health insurance can still feel difficult to navigate. Knowing who to turn to as you have questions and compare plans is crucial. Speaking to friends, family, colleagues, and neighbors can be helpful in learning about others’ experiences, but we always recommend talking to a trusted expert. When considering how to find an insurance agent you can trust, this read may be helpful.
As an independent insurance agency, Price & Ramey can help you compare plans from the leading healthcare carriers to ensure you have the best coverage for your unique needs. Talking directly with an independent agent is the best way to see your options, and ask questions to a trusted advisor throughout the process. Contact an agent today and get the health coverage you and your family need.