There are several factors to consider when comparing health insurance plans; monthly cost, total annual cost, quality of care, in network doctors, reviews by customers, how many people need to be covered under the plan, and what your medical needs are.
Cost:To determine the cost of a plan look at the deductible and the maximum out of pocket total amount. The deductible will be the amount of money you will need to spend before the health insurance company will cover any of your medical costs. The maximum total amount out of pocket the the highest amount of money you will need to pay before the health insurance company will cover all your bills. Often times the deductible will be lower than the maximum. So if you deducible is $3,000 that is the amount of medical costs you will have to pay out of pocket before health insurance will help cover some or a portion of your bills. If your maximum annual out of pocket is $7,000, than after paying $7,000 you will not have to pay any more for health bills, no matter how much you charge. Often times the lower plans like the bronze and higher plans like the gold will have a similar total maximum out of pocket cost. To determine the total cost you will pay for a plan add the max out of pocket annual to the monthly rate you will pay. For example if your maximum out of pocket cost is $7,000 and your monthly plan is $300, the absolute most you could end up paying is $10,600 in medical bills.
Quality of care: quality of care is often what differentiates the catastrophic and bronze plans from the silver, gold, and platinum plans. This is because the higher coverage plans will often have more choices of doctors, which means access to shorter wait times and higher rated doctors.
Medical needs: coverage needs will vary from person to person depending on age and current health status. Health coverage can broadly be broken down into 2 categories; primary care and emergency care. Primary care is for your employees health maintenance are includes such aspects of care such as doctors visits, routine screenings, and the medications they take. Emergency care is what is covered after a car accident or other emergent matter like a heart attack and includes aspects such as ambulance transport, ER visits, and hospitalization. Of course these two aspects of care are fluent and often occur together, but health insurance companies will often group co-payment pricing by these two categories. The lowest level plans such as the catastrophic and bronze will often cover emergency care after a high deductible, while the more expensive plans such as silver and gold will cover both primary care and emergency medicine at a lower deductible. If you are someone who only goes to the doctor once per year then a plan like the bronze may not be a bad choice. However if you have chronic conditions that need constant follow up than a higher coverage plan may be preferred due to their higher quality of care rankings. Most health insurance websites will ask you medical related questions such as how often do you see your doctor or how many medications do you take to help gauge your medical coverage needs.
Family versus Individual plans: individual health plans will cover just yourself while family plans will cover yourself plus your spouse and any children (by birth or adoption) under the age of 26 years old. Children can stay on the family plan even if they are no longer being claimed as dependents on their parents taxes. Both same sex and opposite sex domestic partners are also covered under family plans. Generally covering yourself and your dependents under a family plan is more cost efficient then every member of the family having their own individual plan. It is often helpful to compare your employers health insurance plan options to your spouses and go with whoever is being offered the better plan.
Comparing Insurance Companies:
For those who have insurance offered to them by work, they will likely have only a few plans to chose from, which in some ways makes the process more simple. For those who are buying private insurance you can visit sites like health.gov or einsurance.com to find plans. You will first be asked to answer a few simple questions like age, sex, income, and some may ask medical needs questions. After filling out the from you will be shown all the health insurance options in your zip code.
How to decide which insurance company to go with?
Checking the reviews of the insurance companies by customer and looks at the benefits are a good place to start. All health insurance companies will have review sections that are written by customers like you. In addition, sites like health.gov will show plans that are “high ranked” or “popular choice.” Often times larger companies like blue cross and kaiser, who have more customers are able to offer slightly better rates than the smaller companies. However, you medical needs may lead you to a smaller health insurance company.
When comparing the benefits it is wise to think back on your past medical history and your future health. Are you someone who only goes to the doctor once a year, but are into extreme sports and therefore at risk for broken bones and possible hospital stays. When looking at the benefits offered you will want to take a look at the imaging and hospital stay sections. Or are you someone who has many medical conditions, takes over 5 medications, and needs to be seen regularly by your PCP and specialists. Someone like this will out to look at the PCP, specialists, medication, and hospital stay as you will likely have a high yearly medical bill.
Another factor to consider is the doctors and medical providers that are covered by the company you choose. Lets say you looked over the plans and liked the blue cross silver plan, but your current PCP who you don’t want to give up is in the Kaiser network. If the Kaiser silver plan and the blue cross silver plan are similar, you may want to choose the Kaiser company instead. For companies such as Kaiser all doctors and medical providers that you see will be inside the Kaiser network. You will even need to go to the Kaiser pharmacy to have full coverage. Some people like this model, because it keeps all your medical providers in one big umbrella network.