Choosing a health insurance plan can be a difficult job, especially when you cannot decide amongst the numerous companies available today. There is also the issue of Insurance terms, or what is called the “insurance Language,” that you will need to understand in order to choose the right policy for you and your family.
Well, worry not, because in this article, we shall be looking at the health insurance industry, in every aspect. We shall tell you the terms you need to learn, how to choose the right company and also sample for you some of the best in regards to your needs.
Let's get started:
Now, there are three main ways of getting health insurance, one is through the federal government, the second is through an employer, and the third option is purchasing a health insurance policy directly from an insurance agency or the insurance company.
If you are employed, and your employer offers you health insurance as part of the workplace benefits, then you do not need to go through the federal government. Most employers, however, offer health insurance, by paying a portion of the premiums, and hence they tend to get the least expensive options.
As such, people who need more than the employer offers will have to do it on their own through the government or the private policies.
Here are some health insurance words you will need to know
Monthly premium – This refers to the payment you shall be making per month for the health insurance. It is worth asking your insurance provider if you shall be getting discounts whenever you pay in advance, or if it is at all possible to set up some direct payments from your bank.
Deductible – This is the amount you shall be required to pay, and it is nor inclusive of preventive care. It is payable before the company starts paying out. A low deductible plan will offer you a deductible of about $500, but if you choose to go for a higher deductible, you could have pay-outs of up to $6,600.
Maximum-out-of-pocket – This is the maximum amount you will be required to pay out of your pocket. It is sometimes more than the deductible. You may find someone paying a deductible of $1,200 and an out of pocket amount of $1,500. Please note that this doesn’t count as your premium.
Preventive care covered – Some insurance companies typically include preventive care. They can cover these visits up to 100%, but some may limit it to a specified number of check-ups, or they may allow specific procedures such as mammograms.
Prescription plan – If you take maintenance medication, look for an insurance company that has an above-average prescription plan. Also, check to see if it covers the medicine that you are currently under, or if it offers suitable generics.
Out-of-network vs. in-network coverage – In-network providers are normally discounted, and you will pay more for out-of-network covers. It is always advisable to contact your medical practitioner to find out if they are preferred providers.
Types of Health Insurance Plans
Here are the plans available in most companies;
Preferred Provider Organization – PPO:
This insurance plan provides better coverage to all its clients within the network. The insurance company and the provider agree in advance on billing, for common procedures. Any other person who is not one of their members, or wants to pay out-of-pocket will not be covered, or they will pay much more than those within their network.
Health Maintenance Organization – HMO
With this type of plan, you are only allowed to work with one specific doctor, and if you need any other additional testing or procedures to be done, it has got to go through them. You will also need a referral from the doctor if you need to see a specialist unless it is an emergency situation.
Exclusive Provider Organization – EPO
This is a plan that limits their network to specific doctors and hospitals who are within their network. Any out-of-network doctors or even hospitals will not be covered.
Point of Service – POS
This is a type of plan that mixes both PPO and HMO. You will, however, need to use a primary doctor in order to coordinate your care, but you are allowed to see any doctor you want. If you go to a provider that is outside the network; however, you will need to pay the bill yourself and then submit it as a claim to the insurance company for a partial disbursement.
High-Deductible Health Plan – HDHP
This is a plan that has a very low monthly premium and a high deductible. In most cases, you will find a deductible of up to $6,600.
Health saving and flexible spending accounts;
These are not actual insurance plans, but they offer ways of assisting with medical expenses by use of pre-tax money. The companies using this plan normally have a high-deductible plan. Their flexible spending plans are normally use-it or lose it, but their plans typically roll over to the following year.
Short-term medical plans:
These are meant to fill in the gap between your covers. If, for example, you are changing jobs, there may be a gap in your coverage before your new employer takes over, and this is where the short-term comes in.
This came into effect in 2010, and it impacted the insurance companies in many different ways. It states that you need to have a health cover for at least 9 out of the 12 months in a year, in order to be subject to a tax. The rule has many exemptions based on things such as financial hardship, living situation, annual income, etc. All in all, whether you decide to use Obamacare or not, everyone should have health insurance.
Health Insurance companies you can choose from
Best overall insurance company – Blue Cross Blue Shield Insurance Company:
This is a longstanding company that offers you plenty of options, and it ensures that there is a plan that can meet your needs. It is also a company that operates in all the states in America, and in addition, you can find them in over 170 cities worldwide.
Over 99 million Americans are covered by Blue Cross Blue Shield company, and there are also over 39 separate Blue Cross organizations scattered all over the US, with most of them having a financial strength rating of A+ for excellent.
This company offers small businesses with less than 50 employees health insurance covers for their staff, and it is one of the best health insurance companies in the country, due to their reasonable rates and high-quality service.
Best Short-term Health Insurance Company – UnitedHealth Group:
UnitedHealth Care Group is an American company that is based in Minnesota. It is a fortune 500 company that offers a wide variety of services, including short term insurance policies for people who need to meet the related needs at an affordable cost.
It has been offering short term policies for a while now, and their services are unparalleled. In addition to short term policies, they also offer a wide range of other services which cater to a diverse group of people. Whatever your needs are, you can be sorted by UnitedHealth Group.
The reason why they are one of the best health insurance companies is the fact that they have an open-access plan which means that you can be able to see any doctor you want or visit any hospital you want within your plan period.
They also offer substantial discounts to any employee that uses their in-network care, but you must obtain approval whether you are using in or out of network plans.
Best Individual Health Insurance – Aetna:
Aetna is one of the most affordable health insurance company in the market today, and this is why it is ideal for individual care. It is also one of the largest in the nation and has a rating of A+, in terms of financial strength.
It comes with an open choice plan that gives you access to any doctor and health facility you want, but, its out-of-pocket charges may be high if you visit a doctor who is not a part of their network. Licensed and specialist doctors are however accepted.
The company has an active support department, and it is also very active on social media to deal with any problems that may arise and to also give approvals where necessary.
Best Health insurance for young adults – Cigna Health Insurance Company:
If you are in college or recently out of school and you love to make your own choices and decisions, then Cigna Health Insurance Company is one of the best for you. You must, however, choose the right plan that will accommodate your budget.
This is also a great company for young adults who can no longer be covered under their parent's policy. These are people over the age of 26.
Their rates are reasonable and affordable. They also offer many different plans under their policy which ensures that you get what you are looking for. You can choose from HMO, PPO or even EPO.
Best Travel Health Insurance: Travelex Health Insurance Company:
Finding the best insurance company while travelling is not very easy because you will need a company that will protect you from paying exorbitant amounts of money on medical care while you are traveling abroad.
While most health insurance companies in the US will not cover you while you are outside the country, as long as your policy is paid for, Travelex will cover you wherever you are, as long as they are represented in the said company.
Here is why you should consider them
Your kids will be covered as well – When you purchase the policy as a parent, your kids will be automatically covered absolutely free. This is why most people love it when going on vacation. It doesn’t matter how large your family is; they shall all be covered.
There is a pre-existing conditions waiver – for most companies, pre-existing conditions are not normally covered, but with Travelex, they will cover you even for conditions that were in existence even before you took out the policy. The only rule for this to be effective is that you must take out the policy 21 days before you travel.
It covers adventure sports – Well, most people who go on holidays tend to go for adventures, which can sometimes become pretty dangerous. With this policy from Travelex, you are well taken care of, regardless of how adventurous you get on your vacations.
Health Insurance Company with the best and most useful app – Kaiser Permanente:
This insurance company makes it very easy for you to sign up, pay and use the policy, by simply downloading the app on your android or apple phone. It is also very well-designed and easy to navigate from page to page.
It has a map feature that shows clearly where each doctor or healthcare provider is located, and you simply need to follow the map to find what you are looking for.
Another incredible feature with the app is that it is multi-lingual and has interpreters who can easily the medical information for those who are unable to read and understand English.
Kaiser Permanente comes with extremely low rates, making it one of the most affordable health insurance companies in the country. It, however, works with a limited number of healthcare providers and doctors who are within its network.
Before signing up with this health insurance company, ensure to check the list of select doctors and hospitals, to ensure that only the best from your area are included.
It offers coverage to 8 states namely; Colorado, California, Maryland, Virginia, Washington, Oregon, Hawaii, and Georgia.
It also covers one other area namely – British Columbia, and this is an extra location with 38 hospitals, 17,425 doctors, plus, 618 outpatient and medical offices for specialized care.
The best Health insurance company for seniors – Humana Insurance:
This insurance company is only available in 22 states, and within these states, if you are 45 years and above, then you get to pay very low premiums compared to other insurance companies.
For clients who are incredibly advanced in age, the insurance company offers a home health care plan. This is useful for people who have chronic health conditions which impact their mobility and their ability to work and live alone.
It doesn’t have short-term plans or plans for people who are in-between insurance companies, however.
Here's how to choose a health insurance company
Identify whether you need the policy or not:
As stated above, most people are able to receive an insurance plan from their employers, but if this is not the case for you, then, you may need to find one that works for you and your family members.
Another reason would be if the plan provided by your employer is not enough for you, and you are looking for a better option, then you may need to look for a good insurance company to accommodate your additional needs.
You can opt for a government offered health insurance plan, or you can purchase a policy directly from the private health insurance companies, and the options available have been outlined above. These are reputable companies that deliver good quality of services to their members.
Compare the types of health plans:
In your quest for a good health insurance policy, you will encounter some alphabets such as HMO's, EPO's, PPO's, etc. These have been clearly explained above.
What you should look for is the summary of benefits. Most online websites will show you the cost and summary of the policy near the title of the benefit. There is usually a provider directory with a list of hospitals and doctors that are a part of the insurance company's network.
When comparing the plans as well, put yours and your family's needs under consideration, do extensive research on the trends of each company because this will give you an insight into what the company can, and cannot do.
The best plans are HMO and POS, that is if you do not mind that your primary care doctor will have to choose the specialists for you. A significant benefit of this system is that you will end up doing less work, as the primary care giver's staff will be coordinating your visits and handling your medical records.
If you want more freedom in choosing your own doctors, then you should opt for an EPO or PPO system. An EPO has lower costs when you choose doctors within their network, while PPO is the best if you live in a rural or remote location.
Compare the Health plans for each company:
When you go to an in-network doctor, the costs shall be lower. When you choose to visit an out-of-network doctor, you will be required to pay out-of-pocket.
You should, however, choose a health insurance company that offers to reimburse you any costs you pay when receiving medical care.
If you have a doctor whom you prefer, then ensure that they are within the network of the health insurance company you want to choose. An easier way of doing this is to visit the doctor and obtain from him the list of the companies in which he is a member.
Do not choose any plans that don’t have few provider options and those that do not include a local- in-network doctor in their list.
Look at the out-of-pocket costs:
You must establish how costs are shared with each health insurance company. Any company will show you how much you have to pay out-of-pocket in their summary of benefits. The website for the federal marketplace has a snapshot of some of these costs.
You should, however, arm yourself with the vocabulary of words used in the health insurance circles such as co-payments, deductibles, and even coinsurance. Understanding what different words mean, will help you in making the right decision.
The total amount of money you shall spend out-of-pocket in a year shall be listed with the plan. One thing you should remember is that the lower your monthly premium shall be, the higher you shall pay out of pocket.
Cost-sharing options must also be considered. Your goal should be to narrow down choices based on the total amount you pay out of pocket. Any plan that pays for you a high portion of your medical bills but requires a high monthly premium is the best option for the following type of people;
- People who frequently see their primary physician or specialist.
- People who require emergency treatment frequently.
- People who use brand-name medications frequently. These are expensive.
- If you are planning to have a baby in the near future, or are already pregnant, or if you have small children in the house that require constant care.
- If you have a planned surgical procedure coming up soon.
- If you recently received a diagnosis for a chronic condition, e.g. cancer or diabetes.
On the other hand, a plan with a higher out-of-pocket cost and a lower monthly premium is most ideal when;
- You cannot afford to pay a higher premium.
- If you do not frequently go to the hospital.
- If you do not have a chronic illness.
When choosing a health insurance company, be extra vigilant, because you may find a nice/legitimate-looking company online which turns out to be fraudulent after you have already become a member and paid some premiums.
In Florida, a fraudulent insurance company was forced to close down by the government after it had already collected more than $100 million in benefits and premiums.
The con men, say that it is easy to defraud the general public as most people are uninformed when it comes to medical covers. Here are some tips to help you out;
- Always try to stick to the big company names that have been in operation for many years.
- Do not use a company whose representative is fishy and doesn’t even pick your calls.
- Do not give out your banking information or credit card info before checking out all of the policy details.
- Call a few hospitals and doctors listed in their network to verify whether they are legitimate.
- If you do not receive an email with your policy information or your health insurance card, then, they were probably cons.
- Be extra careful with deals that seem too good to be true.