How to Choose A Health Plan

Whether it’s the start of a new job, open enrollment, or a qualifying life event, there are a number of situations in which you get the opportunity to select a new health plan. Choosing a plan that’s right for you and your dependents will ensure that you get the coverage you need at a price that fits your budget. But with all the employer and individual options available, where do you start and how do you compare providers and plans? Use the following tips to make a smart choice for your personal health needs.

Compare Employer-Sponsored and Individual Plans

There are several important things to consider when changing plans and comparing different options.  It’s a good idea to start with a review of your current or previous health plan. Were you happy with your plan? Do you anticipate any major changes or events? Are there any changes you need to evaluate? Asking yourself these questions may help point you in the right direction when comparing plans and providers.

Next, decide between an employer-sponsored health insurance policy (if applicable) or an individual plan. An employer-sponsored health insurance policy presents you with a chosen provider and selected plan options. You may not be able to change providers, but you can still evaluate your plan options. 

Alternatively, you may decide an individual plan under the provider of your choice is better suited for you. Though employer plans typically help contribute to coverage costs, competitive individual plans can make more sense financially in some situations. Speaking to an insurance agent can help you select the best provider and plan. If you already know your provider, their website will likely allow you to compare multiple plans.

When comparing plans, there are several things to keep in mind. Below, we’ve highlighted some of the most important factors to consider as you make an informed selection.  

Understand the Basics of Plan and Network Types

Every health insurance plan is categorized by different metal ratings: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. 

Additionally, there are different plan and network types to be aware of. Examples include HMO, PPO, POS, HSA, and EPO. There are notable differences between each type. You’ll want to consider the following when it comes to plans

• Premium costs
• Plan costs
• Primary care doctors and referrals
• Filing claims

All private health insurance plans work by partnering with networks of health care providers. The way these plans work with the networks can vary significantly, and you want to make sure you understand the differences between these plans. 

Identify Your Needs

Just as everyone’s health is unique, so are your health plan needs. As you look at different plan options, think about what’s important for you:

• Do you want to keep your costs for medical services as low as possible?
• Are you satisfied with being restricted to a specific group of doctors?
• Are you willing to pay more for direct access to specialists without authorization?
• Are there specific services or treatments you would like covered?
• Do you or a family member regularly use prescription drugs, and are the drugs you need covered on your desired health plan?

If you already have health insurance, here are three things to consider during open enrollment. Reviewing what you like or don’t like about your current plan can help form a basis for comparison. You should be able to view your network of providers on your insurer’s member portal or in a network provider directory.

Consider Your Doctor

Some plans dictate who your primary care physician is, and other plans allow you the flexibility to pick a doctor. Choosing the right doctor is a very important decision to make. They will impact how any medical care you receive will be handled. Improper care can ultimately affect your health in negative ways.

When choosing a primary care physician, you’ll want one who:

• You can trust
• Helps you stay healthy by recommending preventative services, like screening tests and vaccines
• Treats many health problems
• Has connections to specialists when you need more help with a specific health issue
• Treats you with respect
• Listens to your opinions and concerns
• Encourages you to ask questions
• Explains things in ways you understand

Check with your health plan to find out whether your preferred doctor is in their network. You can also ask the provider about associated costs for out-of-network doctors. At Bella Terra Primary Care, Dr. Karki accepts most PPOs, Medicare, and HMOs under Monarch and Optum (formerly Healthcare Partners).

Analyze Costs

When analyzing your healthcare plan costs, look beyond the premium. You pay a monthly bill to your insurance company (a “premium”), even if you don’t use medical services that month. 

Try to estimate your total yearly cost using the HealthCare.gov tool, which takes into account the plan's deductible — how much you have to pay out-of-pocket for covered services before your insurance picks up the tab — and copays as well as how many healthcare services you expect to use in the coming year. This will help you better understand healthcare plan costs with your budget in mind.

Consider Healthcare Usage

Picking the right provider and plan involves a little guesswork about how many health issues you’re likely to face in the coming year, which could affect the way costs break down. While there’s no way to predict your health needs with 100% accuracy, you can leverage what you know about your personal health and your family’s health history and factor in your age to estimate your potential plan usage. 

There are general tradeoffs when it comes to comparing plans. You could pay more in monthly premiums knowing that would mean less out-of-pocket expenses when and if you need more medical care. Alternatively, you could pay a lower monthly premium if you don’t anticipate needing much care beyond basic checkups and screenings.

Whether you're aging out of your parent's plan and picking one for the first time, you're in a plan that no longer works for you and you're ready to switch things up, or you're uninsured and want to see if you have any workable options, there's good news. Keeping these tips in mind can help you zero in on the right provider and plan. If you’re looking for a new doctor, contact the staff at Bella Terra Primary Care.