Things to Know Before Signing a Health Insurance Plan in the US

The road to choosing a health care plan can be complicated. What with all the confusing insurance terminology and clauses. Having health insurance is not only important but also mandatory in the U.S. Whether you plan to purchase your own medical coverage or you’re applying for one at work, there are things that you should consider apart from asking how much it will cost. Here’s a list of seven things you should know before signing a health insurance plan in the U.S.

1. Where to Buy Your Health Insurance

If you’re employed, getting a health insurance coverage through your employer will cost less. Usually, you have the option of buying into a group plan, which comes in handy especially if you have pre-existing health conditions. If your employer offers a health care plan but you want an alternative medical coverage, you can search the marketplace or government insurance exchanges. The same applies if you don’t have access to health insurance, either through work or parents. You can also purchase health insurance directly for the insurer.

By simply entering your ZIP code in the website, you’ll be able to check if state-based marketplace exists in your state. Otherwise, you’ll have to use the federal marketplace. It’s important to note here that premium subsidies aren’t available if you purchase your health insurance through a private exchange or a health insurance company. The subsidies are discounts on your monthly premiums based on your income and you’re only eligible if your income doesn’t exceed the 400 percent of the federal poverty level.

2. Which Health Insurance Plan Do I Choose?

There are two types of plans available:

  • In an indemnity health plan or fee-for-service plan, you cover a certain percentage of the medical bill and your insurance company offsets the balance. You can choose your own doctors with this plan.
  • Managed care system. Here, you’ll come across several terms and abbreviations. They include – HOM (Health Maintenance Organization), PPO (Preferred Provider Organization), and EPO (Exclusive Provider Organization).

With HOMs, you can only go to a doctor who has a contract with the HOM. Monthly payments for your health services are paid for either by you or your employer. With a PPO, it will cost you or your employer less if you go to a doctor who’s within the plan or in-network. You can go to a different doctor but you’ll have to part with more fees.

3. Pick the Most Suitable Health Plan Networks

Insurance companies lower rates when you use in-network doctors. This means your costs will be lower compared to when you go to out-of-network providers. The simple reason doctors without contracted rates will cost you more is that the insurance company pays a higher rate. It’s advisable to find a plan covering a larger network since you’ll have more options. This is especially beneficial if you live in a rural community where you can find a doctor who accepts your medical plan.

Generally, avoid plans which limit your provider choices.

4. Does the Plan Cover My Current Doctors?


Before choosing a particular plan, ask if there are limits on your choice of doctors. You may want to confirm that the insurance plan you’re considering covers your current doctors. HOMs limit you to use doctors in their network only. PPOs allow you to use your doctor, but you end up paying higher. Request for a list of doctors and hospitals covered by the plan you want to choose before making your final decision.

5. What Benefits Are Covered?

Know what benefits are covered and not covered by your preferred medical coverage choice to avoid inconveniences. This will help you narrow down your hunt for a good health care plan. Some plans may provide better coverage in fields like emergency coverage, while other plans may be good at physical therapy. Ask if your medication is covered in your plan. You also want a plan that covers services such as maternity coverage, dental care, routine examinations, coverage while you’re traveling, vision care, and other special services.

6. Lower Premiums Don’t Necessarily Mean Cheap

At first, you might think that the lower premium rate is a money saver. But, soon you’ll be bombarded by all sorts of fees here and there. For instance, you’ll be paying co-pays, a small percentage of costs, every time you use a service. There’s also the annual deductible which you must pay out of pocket every year before your insurer chips in. That’s why you should confirm the out-of-pocket costs each plan will require you to pay.

You can find a comparison of this information in the federal marketplace. Overall, the higher your premium, the lower your out-of-pocket cost, and vice versa. It’s, therefore, crucial that you consider your needs and that of your family instead of basing your health insurance plan on budget alone.

7. How Reliable is Your Health Insurance Company?

You want to deal with a health insurance provider that acts promptly when it comes to settling disputes. It’s important to inquire about the turnaround time for resolving issues from the company you’re considering. Additionally, you need a company you can rely on 24/7 for urgent help. Something might happen while you’re on vacation and knowing there’s someone you can turn to for immediate help may be comforting. You’ll be better placed to make a wise decision based on this fact.

All images via Pixabay



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