During open enrollment, many families are rethinking their health insurance coverage – and rightfully so! Health insurance is a colossal expense for most people regardless of your current lifestyle. Being able to find the health insurance coverage that allows you the flexibility you need to find specialists or primary care doctors who meet your health requirements while balancing cost and quality of coverage is the goal when exploring your options.
Health Insurance Plan Types
Health insurance is by far one of the biggest workplace benefits you should be taking advantage of as an employee. There are several different types of insurance plans, and determining what’s going to work best for you and your family means carefully weighing the pros and cons of each.
You can usually select from:
- HMOs (Health Maintenance Organizations)
- PPOs (Preferred Provider Organizations)
- EPOs (Exclusive Provider Organizations)
- POS (Point-Of-Service Plans)
- HDHPs (High-Deductible Health Plans)
Within these options, your plan provider may also offer different tiers of coverage ranging from Bronze to Platinum.
An HMO plan offers health insurance coverage through a network of providers. This means that you have less flexibility when picking your health care providers (everyone from doctors to hospitals), and you need a referral from your primary care doctor to work with a specialist. HMOs offer the least flexibility for picking health care providers, and it can be costly if you choose to go out of network.
A PPO plan offers significantly more freedom but still requires you to operate in-network to receive the full coverage their health insurance offers. The freedom a PPO plan offers is that you don’t have to speak with a primary care doctor for a referral to see a specialist. If you choose to see an out-of-network health care provider, you can expect to pay more out of pocket. Many PPO plans require that you pay your out-of-network provider out of pocket in full, then file a claim with them to get reimbursed.
An EPO allows you to choose your health care providers within a network but provides no coverage for providers who are out of network. They often have lower premiums than a traditional PPO or HMO, and you don’t need to get a referral from a primary care doctor to see a specialist. There is no coverage if you choose to see an out-of-network care provider, you’ll have to pay the full price of your care in full.
POS plans allow you the flexibility to choose health care providers, require you to fill out some paperwork to see out-of-network care providers, and you have a primary care doctor who coordinates your care and refers you to specialists. If you have a POS plan, you can see out-of-network care providers, but you’ll likely pay more (although you’ll usually still receive a small reimbursement by submitting a claim to your health insurance provider).
HDHP insurance plans offer lower monthly premiums and higher deductibles. For people who don’t expect to incur consistent medical expenses, and are willing to put money aside in a Health Savings Account (HSA) for potential medical emergencies, this may be the option for you.
What’s Best For You?
This open enrollment period, you want to make sure that you select the health insurance plan that’s best for you and your family. When you’re in the process of making this decision, you have a few things you need to consider:
- What is the monthly premium?
- How flexible is your plan with seeing specialists or out-of-network doctors?
- What’s your deductible, or out-of-pocket maximum?
- What health care providers are in your network? Do they come recommended?
You’re looking to find a balance between affordability and quality of coverage. To make the best possible decision for you (and for your wallet), it’s smart to sit down and think through your health insurance needs. For example, if you have young kids who still get regular check-ups, and tend to be adventurous tree-climbers or school-sport participants, you likely want a plan with a lower deductible and flexibility for choosing health care providers in case of an emergency. Alternatively, if you’re an empty nester and a pre-retiree who is relatively healthy, a plan with a high deductible (and a low monthly premium) with the ability to open a HSA or a traditional savings account earmarked for emergency medical expenses may be in your best interest.
Do you need help navigating your health insurance options? Reach out! I’d love to help walk you through what options your employer provides, and what choice fits best into your current medical needs and long-term financial goals.