How to choose a health insurance policy
Being smart about choosing your health insurance plan can save you thousands of dollars and a lot of pain and suffering.
Given the high cost of major medical treatments, health insurance is a must for just about everyone. But health insurance policies vary wildly in cost, coverage, and other features, so it’s important to choose your plan with your individual needs, resources, and medical history in mind.
Identify your source
If you’re fortunate enough to have employer-provided health insurance, that narrows your options down to the plans that your employer offers. If you don’t have coverage through your job, perhaps an organization or association that you belong to will allow you to buy health insurance through them at a group rate.
Another option is to check your local Obamacare health insurance marketplace to see if you qualify for an upfront premium credit, which would get you reduced premium costs. Even if you don’t qualify for the credit right away, buying your health insurance through the marketplace means you may qualify for it when you file your tax return for the year.
If you can’t, or won’t, get health insurance from any of these sources, you’ll have to fall back on buying a private plan. It will give you the widest range of options, but likely will be far more expensive.
Decide which type of policy to buy
Health insurance policies come in a variety of basic types, although you may not have access to all of these options through your preferred source. Health Maintenance Organizations (HMOs) are a very common type of health insurance policy. With an HMO, you’re required to use healthcare providers within the policy’s network, and you have to get a referral from your primary care physician in order to see a specialist.
Preferred Provider Organizations (PPOs) are also quite common. A PPO health insurance policy has a network, but you’re not limited to in-network care — although using network providers is cheaper — and you don’t need referrals to see specialists.
Exclusive Provider Organizations (EPOs) are a hybrid between HMOs and PPOs. You’re required to stick to the plan’s network, but don’t need referrals for specialists. Finally, Point of Service (POS) plans are a less common option that are essentially the opposite of an EPO. You’re not limited to the POS plan’s network, but do need a referral to see a specialist.
Of the four common types of plans, an HMO or EPO tends to be cheaper than a PPO or POS with the same level of coverage. However, if network coverage is poor in your area, or you’re uncomfortable limiting yourself to network providers, it may be worth paying a little more to get a PPO or POS policy.