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How to Pick a Health Insurance Plan

Choosing a health insurance plan is an important but sometimes daunting task. The first step is to figure out what your options are. Many employers offer health insurance as an employment benefit and the options they provide are usually more cost effective than your options as an individual. If you are unsure about the options provided by your employer, contact them for more information. If you do not have access to healthcare through your employer, you can get insurance through a federal or state exchange. Likely, https://www.healthcare.gov/ is the best place to start and see what options are available to you.

After gathering your options, there will be several to choose from. The four major types of plans are:

  • Exclusive Provider Organization (EPO) - Provide a network of doctors that you are required to use except for emergencies. When seeking specialist services, no referrals are required. This is a lower cost plan, but still allows you to see specialists without referrals.
  • Health Maintenance Organization (HMO) - Similar to EPO, an HMO requires you use their network of doctors. However, you also typically need your primary care doctor to provide referrals for specialist services. This tends to be a lower cost plan, and best used with a primary care doctor who is involved in the other services you are using.
  • Point of Service (POS) - This type of plan also has a network of doctors, but you can go out of network with a referral from an in network doctor. You also need a referral to see specialists. This plan provides a bit more flexibility since any doctor is available to you with a referral.
  • Preferred Provider Organization (PPO) - This plan is the most flexible. You can see in-network doctors or out-of-network doctors, though in-network is usually less expensive. You also do not need to get a referral prior to seeing a specialist.

You should also evaluate the networks of each of your plan options to ensure that the doctors that you want to use are going to be included in your insurance plan’s network. If you are using POS or PPO, you may be able to use doctors out of network, but they will likely be more expensive than the in network providers.

The final thing to consider is your out of pocket costs throughout the year for annual deductibles and copays. Annual deductibles are amounts that you are responsible within the coverage year before your stated insurance benefits start paying for coverage. Copays are amounts that you are responsible for and generally apply to every visit. They typically differ depending on the type of provider you are visiting (primary care visit, specialist, emergency, etc.)

Whichever plan you end up selecting, ensure that you budget appropriately for out of pocket costs and that you receive the correct coverage from your insurance each visit. Many plans also include no-cost well visits, like physicals, so make sure to schedule one with your doctor!

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