When shopping for health insurance, it’s important to consider what your specific needs are and what costs you may face. There are many factors that can affect plan costs, including location, provider networks, financial assistance eligibility and coverage limitations. It’s also helpful to talk with family members or friends about their health insurance experience, particularly if they have a chronic illness or any special requirements.
Most plans offer a variety of benefits, such as preventive care, prescription drug coverage and medical management programs for back pain or diabetes. While these are important to consider, it’s equally important to focus on a plan’s cost structure and the amount of money you will pay up front, before your health insurance starts paying. These costs are captured in the form of deductibles, copayments and coinsurance.
The amount you will pay for services is referred to as the cost share. Health insurance providers set this amount based on the risk they assume, and can be influenced by a number of factors, such as age, tobacco use, geographic area and more. In order to keep costs low, most health insurance plans have a network of preferred health care providers – doctors, hospitals and other care facilities that the plan has contracted with to accept rates that are typically discounted from the “usual and customary” charges. If you choose to see a non-preferred provider, it will generally cost you more.
A good health insurance company is one that has a team of people available to help you with questions and concerns about your policy. They should be available to you 24*7 and be able to answer your queries via telephone, email or live chat. It’s also important to find out if the insurer offers any extras, such as telehealth services or a 24/7 nurse line, as these can be useful and provide additional peace of mind.
During open enrollment, you can make changes to your existing plan (unless you have a qualifying life event). It’s also the perfect time to consider what you like about your current plan and what, if anything, could be improved.
As you shop for a plan, you should be aware that the Affordable Care Act (ACA) limits what insurance companies can charge for certain items or services. In addition, premiums can vary by location as well as the type of plan you choose, such as Bronze, Silver, Gold or Platinum. This information can be used to narrow your options and make the best choice for you and your family’s needs. The New York State of Health website can help you with this. The website lets you shop for and enroll in a health insurance plan, calculate costs and estimated financial assistance amounts, compare plan options and prices, and preview plans before making a decision. It can also help you file an external appeal if your health care provider or insurer denies your claim.