Though you usually have limited time to pick the best health insurance plan for your family, rushing to choose once can cost you in the long run. Hence, you need to do your research and understand what’s being offered for the price, whether it’s coming from an employer or the Federal marketplace. We’ve compiled some information to help you through the process, which will discuss how to choose a plan and what is the best health insurance for a family.
How To Choose The Best Health Insurance For A Family
Choosing health insurance can be overwhelming, even if you’re doing so through an employer. There are many perplexing terms, and going through the process makes you think long and hard about your health and finances. Not to mention, your choice needs to be made on a deadline, so here’s what you need to consider before picking a plan.
Choose Your Marketplace
Many people who have health insurance get it with the help of their employer. If you are in this category, then there’s no need to use the government marketplace because your employer is the marketplace. That is unless you search for a secondary plan in the exchange. However, keep in mind that marketplace plans are likely to cost more because when employers help pay the premium for the worker’s insurance, your total premium is less on average.
If you work for a company that doesn’t provide insurance, your best bet is to check out your state’s public and federal markets to find the best premiums. Begin with Healthcare.gov by entering your zip code, but it must be during open enrollment season.
Compare Types Of Available Plans
You’ll find that shopping for health insurance plans almost seems like alphabet soup – there are EPOs, PPOs, HMOs, and more. The kind of plan you choose will determine which doctors you’re able to see and how much you’ll spend on out-of-pocket expenses.
When trying to determine what the best health insurance for a family is, it’s best to compare the plans and look over a summary of the benefits for each. Most online marketplaces provide a link for the summary where you’ll also find the cost near the title. You should also have access to a provider directory where you’ll find a list of the clinics and doctors who participate in that plan’s network. If your employer offers health insurance, then simply ask the company’s benefits administrator for this information.
Types of Plans: HMO, PPO, EPO, and POS
When determining what is the best health insurance for a family, compare the plans by putting your family’s health under a microscope. For example, look at the types and amounts of care that’s been required in the past. Though you’ll never completely predict every health care cost, being aware of trends can be helpful in making a good decision.
When it comes to the type of plan you’ll choose, this can be tricky. Selecting a POS or HMO plan both require referrals, so you have to see a primary care provider before seeing a specialist. Due to this, most people prefer other types of plans. However, at the same time, HMOs are usually the most affordable option for families.
If you don’t mind that a primary care provider chooses your specialists when needed, then an HMO or POS plan is a great option. There are other benefits as well, such as being a time-saver for you. This is because your doctor’s staff will coordinate and handle all of your medical records between your primary doctor and the specialist. It’s also worth mentioning that if you choose a POS plan and end up going out of network, be sure to get a referral because it will reduce the amount you’ll have to pay out of pocket.
Alternatively, if you want to choose what doctors and specialists you see, an EPO or PPO is the better option. EPOs are great for helping keep costs low so long as you only use doctors within the network, but they may be better for folks living in larger metro areas. If you live in a rural or remote area, then a PPO is probably the best because there are limited care choices, and you may have no other option than to go out of network.
Compare Plan Networks
In general, health insurance costs are less when you go to doctors in your network because your insurance company has pre-negotiated rates with these providers. Since there are no pre-set rates with out-of-network providers, you are typically responsible for more money out of your pocket.
So, if you have specific doctors you want to see, check the plan’s provider directory to see if they are in the network. You can also ask your doctor’s office directly if they accept a specific plan.
If you’re not picky with doctors, then it’s best to choose a plan with an extensive network. This is especially true for families because you never know what kind of issues will arise. If you come across a plan with no local in-network providers, you should skip it altogether.
Consider Out-of-pocket Costs
The most significant contributing factor to choosing a health plan is the out-of-pocket costs required for some. This information should be clearly laid out inside the plan’s summary. And if you’re using a government marketplace, look for the cost comparison tool.
This section is more easily understood if you know a few terms such as copayments, deductible, and coinsurance. Generally, the lower the cost for your premium, the more you’ll pay out of pocket.
This step should be used to narrow down your top choices based on what you’ll have to cover out of pocket. And keep in mind not to discredit plans that pay more of your medical costs, but require higher premiums, as these may be best for those who:
- See primary care providers or specialists regularly.
- Require emergency care frequently.
- Are prescribed brand-name or expensive medications regularly.
- Have been diagnosed with a chronic condition such as cancer or diabetes.
- Have an upcoming surgery planned.
- Are expecting a baby, want to have a baby, or have other children.
Plans with lower monthly premiums and more out of pocket costs may be best for those who:
- Rarely see doctors because they are in good health.
- Can’t afford to pay more monthly.
Compare the Benefits
By now, your list should only have a few options left, so to narrow down the list, even more, it’s time to analyze the summary of benefits. Some plans may offer better coverage for things such as mental health care, emergency coverage, fertility treatments, or physical therapy.
This step may seem quick and insignificant; the truth is that if you skip it, you may miss out on a plan that’s better suited for your family. Use this step to address lingering questions and call the plan’s provider to ask questions if needed – just be sure to make a list of questions before calling so you don’t forget anything important.
The Bottom Line
When trying to determine what is the best health insurance for a family, it’s important to remember that the provider’s name is less important than the services they’re providing. With that being said, some of the most top-rated and reputable health insurance companies for a family include Aetna, Blue Cross Blue Shield, Cigna, and Humana.