There’s a common belief that having options makes it easier to choose what you’d like. But having too many options might be stopping you from getting the best health insurance plan possible. Have you ever heard of choice paralysis?
When you find yourself facing an overflow of choices, you’re more likely to make the wrong choice. Or no choice at all! That’s why it’s important to figure out what you need from your insurance before even making a choice.
We have 7 questions you should be asking your agent to get the best health insurance plan possible.
What type of plan is this?
There are plenty of questions you can ask. But one of the first should always include what type of plan you’re receiving. The very first type of insurance plan you notice may be the tier system of bronze, silver, gold, and platinum.
The Metal Tiers
Each type determines the amount of coverage you receive. The rule of thumb here is the plan with the lower monthly payments tends to carry the highest deductible.
- Bronze plans have you paying 40% on your medical care, with your insurer paying 60%.
- Silver plans have you paying 30% on your medical care, with your insurer paying 70%.
- Gold plans have you paying 20% on your medical care, with your insurer paying 80%.
- Platinum plans have you paying 10% on your medical care, with your insurer paying 90%.
Though the financial coverage is different, your quality of care does not differ. These average percentages are also not what you will pay for health care. Insurers are expected to pay over the year for other services and benefits. They calculate several factors, like copays to deductibles, to determine the actuarial value (average cost to cover your medical expenses).
But the actuarial value, the percentages you read about, can fluctuate based on the number of services you use from the insurer. That’s why asking “What type of plan is this?” can get you a clear picture as to what you’ll be expecting to pay, can afford, and what to consider for the future.
The Four Types of Plans
Beyond the tiers are plans you should also consider researching. Watch out for these 4 basic types when you consider buying your next plan:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Exclusive Provider Organizations (EPO)
- Point-of-Service Plans (POS)
Each one has a specific set of limitations based on the plan’s network. For instance, an HMO limits coverage to only doctors who work for or are contracted by an HMO. Meaning you might find yourself limited in finding a doctor based on where you’re located.
To get the best insurance plan for you today, contact our trusted agents to further explain your plan’s options.
How much will private insurance cost me?
The best health insurance plan is the one you know the cost of. Being clear about what your expectations and budget are can help your agent find what’s right for you.
Now that seems pretty straightforward, doesn’t it? What you should consider when asking this question is the overall outlook of your future costs. Dig deep into how your current health may impact your future costs. Or even unexpected events
The most affordable healthcare option is a catastrophic health plan if you were to qualify.
But generally, a bronze tier offers a low-cost alternative.
If you’re looking to save on the cost of insurance, you may find you’re eligible for a subsidy under an ACA plan.
Being eligible requires your household income to lie between 1 to 4 times the federal poverty level.
Being qualified for a subsidy means a portion of your premium will be covered by the government. A nice alternative option, isn’t it?
And even if you don’t claim your subsidy for when you qualify, you still have options. The end of the tax year is an ample opportunity to claim your subsidy. Meaning your tax return can have a decrease in your tax reliability. Or even increase your refund!
Rule of Thumb:
When comparing health plans, make sure to take into account deductibles and other costs. Don’t solely make your health insurance decision based on premiums or copays. Look at:
- out-of-pocket maximums.
Check out how your private insurance plan from First Family Insurance can find you similar savings.
Are my primary care doctors in this network?
One major deal-breaker in purchasing a plan is your insurer’s network. Many insurance providers offer helpful tools to track down what doctors in your area are within their network.
But to get the best insurance plan for you, clarify your preferences to your agent. It will help you determine the type of plan you need (remember question #1) to purchase. Save yourself the pain of needing to relocate for your network, future out-of-plan costs, or deciding on a specialist.
How will this plan cover my previous medical conditions?
There is a common misconception that a previous medical condition can alter your rates. Or even deny you coverage altogether. Since the Affordable Care Act came into place, it is illegal to raise insurance premiums or deny coverage based on previous medical history.
However, you should consider how your plan covers your current medical conditions. Will it cover experimental treatments? Will your previous prescriptions be covered on a new plan?
Whatever questions you have, never feel that you can’t explain your previous medical conditions with our agents. Your best plan comes from being upfront about what you’re experiencing. And the expectation you have of your plan’s abilities to handle your conditions.
What medications are covered by this plan?
In question 4, you may have noticed another question pop up. Will your previous prescriptions be covered? Your plan will demonstrate the differing costs between tiers. View and discuss the prescription list offered by your insurer. Many agents can also help you find an affordable alternative. And even find a home delivery option for you.
Does my plan cover alternative or experimental therapies?
You may find yourself in a position to be searching for experimental therapy. Your doctor may even recommend one to you. But how does your insurance handle what could be life-saving therapy?
You have a few options to consider. Your agent can break down exactly what your plan covers. And whether your concerns can equate to a medical necessity for experimental therapy.
In many cases, you may need to file an appeal. Your agent can discuss the appeal process with you. Or you can look further into detail how the process works here.
What benefits can I receive?
The best question to ask your agent is what benefits you can expect to receive. Why? Because your plan should be working for you at the end of the day. Consider if your plan offers:
- Online app access
- 24/7 customer service
Some benefits may outweigh others. Perhaps you travel a lot, meaning you’ll need access to your care after hours. Or your vision is a concern for you. Figuring out what benefits your current needs will narrow down the best insurance plan for you.
Benefits of Private Health Insurance
Unlike your employer’s insurance, private health insurance benefits you in one major way:
Private health insurance providers, like First Family Insurance, provide you with tailored insurance. Consider it as a stack of legos being arranged by you. You’ll have a variety of options like:
- Insurance companies
- Plan types
Writing out your needs helps you know exactly what questions to ask your insurer. And with these questions, you’re more likely to know what works for you currently. Follow us online to learn more about your insurance options, tips, insights, and more.