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Tips for choosing the right healthcare plan

Choosing the Right Healthcare Plan

Need some tips on choosing the right healthcare plan? As open enrollment approaches, here’s what you should keep in mind!

Understanding The Different Types of Plans

Deciding on a healthcare plan can be a daunting task. The terminology, cost breakdown, and benefits structure can be overwhelming, especially for those choosing a plan for the first time. However, taking the time to fully understand your options is important to get the care you need at a price point that’s right for you. Here are the most common types of plans available today:

  • Health maintenance organization (HMO): HMOs require you to choose a primary care provider (PCP), who will help manage and coordinate your care personally. You must see your PCP for referrals to specialists, such as a dermatologist or a surgeon. 
  • Preferred provider organization (PPO): PPOs give you more flexibility in choosing care providers and hospitals. You can see any provider you want, but you’ll pay less if you see providers within the plan’s network.
  • Exclusive provider organization (EPO): EPOs are similar to HMOs, but you can only see providers in the plan’s network.
  • Point-of-service (POS): POS plans combine features of HMOs and PPOs. You must choose a PCP, but you can see specialists without a referral. However, you’ll pay a higher out-of-pocket cost for seeing out-of-network providers.

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Tips for Choosing the Right Healthcare Plan

Consider your budget and needs: When choosing a healthcare plan, it’s important to do so with your budget in mind. Examine how much you can afford to pay in monthly premiums and out-of-pocket costs, as well as your health history and any pre-existing conditions you may have.

Compare different plans: Once you have a developed understanding of available plans, it’s time to compare! You can reference a health insurance marketplace like Healthcare.gov, or your state’s marketplace to compare plans from different insurance companies.

Check the plan’s network: It’s important to make sure that your providers and hospitals are in the plan’s network to avoid overpaying for care. You can usually find a provider directory on the insurance company’s website.

Read the fine print: Once you’ve narrowed down your choices, be sure to read the fine print of each plan before you enroll. This will help you understand the plan’s coverage, costs, and exclusions.

Additional Healthcare Tips

  • If you have a spouse or children, explore choosing a plan that covers them as well.
  • If you have a chronic health condition, pick a plan that covers the medications and treatments you need.
  • If you’re pregnant or planning to get pregnant, explore plans that offer maternity of fertility care. 
  • If you’re self-employed or work for a small business, you may be eligible for subsidies to help you better afford health insurance.

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