If you are looking for health insurance coverage or exploring the health insurance plans available to you, the process can quickly get overwhelming and complicated. There are hundreds of insurers and thousands of plans out there—how do you find the right coverage for you and your family?
One of the best ways to narrow down your search for health insurance coverage is to find and compare available plans. Conducting a health insurance comparison can help you select the right plan. And if you need additional help or expert advice during your comparison, don’t hesitate to contact a local health insurance provider for assistance.
Health Insurance Comparison: Key Terms to Know
The world of health insurance is famously tricky to navigate—and a significant stumbling block for many people is not knowing the meaning of common terms used when discussing health insurance or comparing plans.
Review these key health insurance terms before diving into a health insurance plan comparison.
Coinsurance
Coinsurance is the share of medical costs that you pay, calculated as a percentage. The rest of the costs are covered by your health insurance plan.
Copayment (Copay)
A copayment, or copay, is a fixed fee that you pay each time you receive a covered medical service or procedure, like a doctor’s visit. Usually, you owe this copay at the time you receive the service.
Deductible
A deductible is the maximum amount you have to pay for covered medical care during a coverage period (usually one year) before your insurance plan begins paying. For example, if you have a $1,000 deductible, you have to spend $1,000 on medical care (not including your monthly insurance premium) before your plan kicks in.
Explanation of Benefits
An explanation of benefits (EOB) is a statement from your health insurance plan that summarizes the total charges for the services you have received, including what costs it will cover and how much you will have to pay for the medical care or products.
In-Network Provider
An in-network provider, also known as a preferred provider or a participating provider, is an individual or facility that has a contract with your health insurance plan to provide medical services at certain costs. Most of the time, it costs less to get care from an in-network provider than it does with an out-of-network provider.
Out-of-Pocket Costs
Out-of-pocket costs encompass all costs that you must pay, other than the monthly plan premium. These costs may include copays, coinsurance, deductibles, and more.
Out-of-Network Provider
An out-of-network provider, also called a nonpreferred provider or a non-participating provider, is an individual or facility that does not have a contract with your health insurance plan to provide medical services at certain costs. It usually costs more to see an out-of-network provider than an in-network provider.
Out-of-Pocket Maximum
The out-of-pocket maximum is the most you will pay out of your own pocket for covered healthcare during the coverage period. Once you reach the out-of-pocket maximum, your health insurance kicks in to pay the rest of the cost of covered services.
Pre-Existing Condition
A pre-existing condition is any disability, disease, or health condition you have before enrolling in health insurance coverage. Since the passing of the Affordable Care Act (ACA), it is illegal for insurers to exclude people based on pre-existing conditions in most cases.
Premium
The premium is the monthly fee you will pay for your health insurance plan. This amount is usually the same month to month and must be paid upfront, regardless of any medical services you have received.
Provider
A provider is an individual or facility that provides medical care or health treatment. Examples of providers include doctors, nurses, registered nurses, physician assistants, chiropractors, psychiatrists, hospitals, rehabilitation centers, skilled nursing facilities, and treatment centers. Many health insurance plans require providers to be licensed, have the appropriate certifications, or be accredited according to state law.
What to Look for When Comparing Health Insurance Plans
When you’re in the market for new health insurance coverage, it’s important to shop around and compare the plans available to you.
Each health insurance plan should come with a summary of benefits detailing information that will be vital to your decision-making. If you are purchasing insurance through an online marketplace like Healthcare.gov, the system will usually provide a link that explains a plan’s costs and coverage as well as provides a directory of the plan’s in-network providers. If you are getting health insurance through an employer, talk to your workplace administrator to get the summary of benefits.
Once you have the summary of benefits for the plans you are considering in hand, you can start comparing three significant components of healthcare coverage: network, costs, and scope of services.
Consider the Health Plan Network
Health insurers work with a network of healthcare providers—individuals and facilities they have contracted with to provide care at a certain cost.
Check the provider directory in each plan’s summary of benefits to see what providers are covered. If you want to keep seeing your preferred doctor or hospital, make sure they are included in the plan’s directory. (If you’re unsure, you can ask your doctor directly.) If you do not have a preferred doctor or hospital, consider plans with larger networks that give you more flexibility.
Review Premiums & Out-of-Pocket Costs
Review both the plan’s monthly premium as well as all the out-of-pocket costs you will be expected to pay. Included in the summary of benefits should be a clear list of how much you would have to pay out-of-pocket for each service, such as coinsurance costs and copays.
In general, plans with higher premiums have lower out-of-pocket costs and plans with lower premiums have higher out-of-pocket costs.
Check the Scope of Services
Look at each plan’s summary of benefits to see what services it provides coverage for. For example, while some plans may prioritize emergency coverage, others could have expanded coverage for things like fertility treatment or physical therapy. Each plan also covers prescriptions differently.
Consider the plan’s scope of services and make sure your medical needs are covered.
6 Tips for Finding Affordable Health Insurance Coverage
There are seemingly endless types of health insurance plans to choose from—and each plan offers a different range of benefits, networks, and prices for different people. Follow these tips as you compare health insurance plans and find coverage that works best for you and your family.
1. Take Stock of Your Family’s Medical Needs & Costs
You can’t predict the future—especially regarding next year’s medical expenses—but looking at past treatment will give you a starting point. Examine the amount and type of medical treatment you and your family have received in the previous few years, and make sure recurring care is covered.
Additionally, if you expect a need for medical care in the future that you haven’t received in the past (such as a first-time pregnancy), take the potential costs into account.
2. Look into High Deductible Health Plans (HDHPs)
High deductible health plans (HDHPs) generally offer lower monthly premiums. The trade-off, as the name suggests, is a higher deductible. However, HDHPs may be a more affordable choice for many individuals and families.
3. Call the Health Insurer Directly
If you have questions about health insurance coverage that you couldn’t find the answer to in the plan’s summary of benefits, don’t hesitate to call the health insurer’s customer service line and speak to a representative directly.
4. Explore Government Assistance Programs
Depending on the unique circumstances of your income and situation, you may be eligible for government assistance programs. Medicaid, the Children’s Health Insurance Program (CHIP), and other programs can significantly reduce the cost of health insurance for individuals or families.
5. Review Current Plan Costs & Benefits
Don’t forget to review your current health insurance coverage. What do you like about your health insurance? What do you dislike? What do you want to change for next year? Look over costs, provider networks, services, and more to set the foundation of your search for a new health insurance plan.
6. Seek Trustworthy Professional Advice
If you’re still overwhelmed by all your health insurance options, talk with an experienced insurance agency, licensed broker, or other insurance professional you can trust to answer your questions and guide you through this process.
Contact Melton McFadden for Health Insurance Coverage in Michigan
At Melton McFadden, our experienced insurance professionals can help you develop a health insurance plan that protects your finances, family, and peace of mind. We are ready to guide you through the process of identifying coverage essentials, finding gaps in your current insurance plan, and creating a solution that works best for you and your dependents.
Whether you are looking to expand your current healthcare coverage or sign up for a new policy, we’re here for you every step of the way.
Contact us today or request a free quote to get started.
