Finance

2021 Guide to Choosing a Health Insurance Plan

By Psquared - May 05, 2021

Time is typically limited to choose the best health insurance plan for your family, but rushing and picking the wrong one can be costly. Here’s a start-to-finish guide to choosing the best plan for you and your family, whether it’s through the federal marketplace or an employer.

Most people with health insurance get it through an employer. If you’re one of those people, you won’t need to use the government insurance exchanges or marketplaces. Essentially, your company is your marketplace.

If your employer offers health insurance and you wish to search for an alternative plan in the exchanges, you can. But plans in the marketplace are likely to cost a lot more. This is because most employers pay a portion of workers’ insurance premiums and because the plans have lower total premiums, on average.

If your job doesn’t provide health insurance, shop on your state’s public marketplace, if available, or the federal marketplace to find the lowest premiums. Start by going to HealthCare.gov and entering your ZIP code during open enrollment. You’ll be sent to your state’s exchange if there is one. Otherwise, you’ll use the federal marketplace.

You can also purchase health insurance through a private exchange or directly from an insurer. If you choose these options, you won’t be eligible for premium tax credits, which are income-based discounts on your monthly premiums.

You’ll encounter some alphabet soup while shopping; the most common types of health insurance policies are HMOs, PPOs, EPOs or POS plans. The kind you choose will help determine your out-of-pocket costs and which doctors you can see.

While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Costs are lower when you go to an in-network doctor because insurance companies contract lower rates with in-network providers. When you go out of network, those doctors don’t have agreed-upon rates, and you’re typically on the hook for a higher portion of the cost.

If you have preferred doctors and want to keep seeing them, make sure they’re in the provider directories for the plan you’re considering. You can also directly ask your doctors if they take a particular health plan.

If you don’t have a preferred doctor, look for a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, since you’ll be more likely to find a local doctor who takes your plan.

Eliminate any plans that don’t have local in-network doctors, if possible, and those with very few provider options compared with other plans.

Out-of-pocket costs are nearly as important as the network. Any plan’s summary of benefits should clearly lay out how much you’ll have to pay out of pocket for services. The federal marketplace website offers snapshots of these costs for comparison, as do many state marketplaces.

This is where it’s useful to know a few health insurance vocabulary words. As the consumer, your portion of costs consists of the deductible, copayments and coinsurance. The total you can spend out of pocket in a year is limited, and that out-of-pocket maximum is also listed in your plan information. In general, the lower your premium, the higher your out-of-pocket costs.