How to find the best insurance can be a time-consuming process, but if you’re in a rush and end up choosing the wrong coverage, it can end up costing you a lot of money.
Whether you’re looking for health insurance through a state, federal marketplace, or employer, here’s a step-by-step guide to finding affordable coverage.
Step One: Find an insurance marketplace
Most people get their health insurance from their employers. If your employer provides health insurance, you don’t have to use government exchanges or marketplaces unless you’re looking for an alternative.
However, plans offered on the market are likely to be more expensive than those offered by employers. That’s because most employers pay part of workers’ health insurance premiums.
You can shop for health insurance on your state’s online marketplace, or on the federal marketplace. To find the plan that’s right for you, start by going to HealthCare.gov.
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Enter your ZIP code and you’ll be directed to your state’s exchange (if there is one). If there isn’t one, use the federal marketplace instead.
Alternatively, you can purchase health insurance on a private exchange or direct from an insurer. You won’t qualify for premium tax credits (which are income-based rebates on your monthly premiums).
Step Two: Compare types of insurance plans
When you’re looking for the right health insurance plan, you’ll run into an alphabet soup of options. The HMO, PPO, EPO, and POS plans are the most common. Choosing the right plan will help you decide how much you’ll pay in premiums and which doctors you’ll be able to see.
Comparing insurance plans: HMO vs PPO vs EPO vs POS
|Plan-type insurance plans||Is it necessary to remain in-network in order to receive coverage?||Do procedures and specialists require a referral?||Detail:|
|HMO (health maintenance organization)||Yes, except for emergencies.||Yes, typically.||With lower deductibles and a primary care physician who manages your care, but less control over which providers you choose.|
|PPO (preferred provider organization)||No, but in-network care is less expensive.||No.||With more providers and no referral requirement, but more expensive in the long run.|
|EPO (exclusive provider organization)||Yes, except for emergencies.||No, typically.||With lower fees and usually no referral requirements, but less flexibility in choosing a provider.|
|POS (point of service plan)||No, but in-network care is less expensive.||Yes.||With more providers and a primary care physician to manage your care, referrals are required.|
Most online marketplaces offer a link to the benefits summary, which outlines all the plan’s fees and benefits.
You should also find a provider directory, which includes a list of doctors and clinics that are part of the plan’s network.
If you’re shopping through an employer, request the benefits summary from your workplace benefits administrator.
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Step Three: Compare plan networks
Your health insurance “network” is the group of doctors and facilities that your health plan contracts with to provide you with care. Why does your network matter?
In-network providers are usually cheaper than those outside of your network because your insurance company negotiates lower rates with these providers.
When you go out of your in-network network, these doctors don’t have an agreed-upon rate and you’re usually responsible for a higher percentage of the costs.
Have you chosen your preferred doctors?
If you plan to continue seeing your current doctors, make sure that they are listed in your plan’s provider directories. You may also want to ask your doctors if they accept your health plan.
Are large networks important?
If you have no preferred doctors, you may want to consider a plan that has a large network to give you more options.
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A larger network is more likely to have a local doctor that will accept your plan. This is especially important for rural communities, as it will give you a better chance of finding a doctor who will take your plan.
Step Four: Compare out-of-pocket costs
Another important factor to consider is OTC (out-of-pocket) costs (costs outside of your monthly premium).
The summary of benefits of a plan should clearly indicate how much you will pay for out-of-pocket services.
For comparison, the federal online marketplace and many state marketplaces have snapshots of these costs.
Step Five: Compare benefits
By this point, you should have narrowed your choices down to a handful of plans. Here are a few things to keep in mind next:
Look at the scope
Go back to the summary of benefits and see if any of these plans cover a wider range of services. Some plans may offer better coverage for services such as physical therapy, fertility treatment, or mental health care.
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Others may offer better emergency coverage. If you skip this important but quick step, you could end up with a plan that is much better suited for you and your family.
Summary: How To Find The Best Insurance
If you’re looking for health insurance, here’s what you need to do: go to your online marketplace and check out all the options.
You’ll need to decide which type of plan is best for your family – an HMO, a PPO, an EPO, or a POS – and if you want to be eligible for an HSA.
Make sure you don’t get a plan that doesn’t have your doctor or any local doctors in your network.
You’ll also need to decide if you want more coverage and higher costs, or lower coverage and lower out-of-pocket costs.
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Finally, make sure the plan you pick will cover your regular and needed care, like prescription drugs and specialists.