In a country that prides itself on a free market, it is often difficult to find good, affordable health insurance. Fortunately, some companies are working to improve the options available for individuals seeking a plan that works for them.
For example, some are offering a high-deductible health plan that allows employees to contribute pretax dollars toward their out-of-pocket expenses such as copays and deductibles. Another option is a health reimbursement arrangement (HRA), which lets employees submit deductibles and other out-of-pocket expenses to the company for tax-free reimbursement.
When shopping for a plan, consumers should weigh the value of different features and costs to decide what makes sense for them. Some of the most common considerations include whether or not they need a doctor or hospital in their network, what type of plan to get and whether it covers the specific services they need.
Consumers should also consider how flexible their preferred providers are. A Preferred Provider Organization tends to have a narrower network of doctors that the insurer will pay for, while a Health Maintenance Organization has more flexibility with out-of-network care.
Lastly, consumers should be sure to read the fine print on their selected plans. There are many details that may be buried within the policy, including how much of the cost a plan will cover after the deductible is met, whether or not they need a referral to see a specialist and how often they can change doctors within their network.
The best way to determine the best fit for a health plan is to consult a summary of benefits, which is a document that lists all the costs and coverages associated with a particular plan. Most online marketplaces will offer a link to this document, or the workplace benefit administrator can provide it.
If a person is in great health and rarely visits the doctor, he or she can afford to choose a plan with a higher monthly premium in order to keep out-of-pocket costs low. However, if a patient needs access to certain specialists or services such as physical therapy or fertility treatments, he or she will want to select a plan with a wider provider network and more forgiving out-of-network coverage.
Finally, those with incomes below 250% of the poverty level can receive cost-sharing reduction (CSR) subsidies, which lower the amount that they owe at the point of service. These are not offered through all plans, but should be considered when comparing options.
While price is often a major factor in choosing a health insurance plan, consumers should make sure they are not overlooking other factors that can add up to significant savings in the long run. For instance, some plans offer discounts on things that improve a person’s quality of life like gym memberships and LASIK eye surgery. These perks can more than offset the cost of the monthly premium and other out-of-pocket costs, such as deductibles, copays and coinsurance. In addition, consumers should be aware that some insurance plans have a maximum annual out-of-pocket expense, which is the highest amount that a person will have to pay in a year for point-of-care charges after meeting the deductible.