With open enrollment for 2015 starting November 15th of this year, it may be a good time to look at your health insurance and what it means for you and your business. There are five key factors that you will want to consider when choosing a plan.
Your premium is the amount you pay to the health insurance company to maintain your coverage (usually paid monthly). When trying to understand the cost of a health insurance plan, the premium is the first thing to consider. Make sure to balance it against other costs, such as co-payments, deductibles and coinsurance.
2) Out-of-pocket costs.
This is the amount you will have to pay for medical expenses (through deductible and coinsurance payments), before your health insurance begins to pay 100 percent of covered expenses. These costs depend on what type of plan you have. If you pay a lower premium then you’ll usually have higher out-of-pocket costs. Healthcare.gov can help you decide on which type of plan will work best in relation to out-of-pocket costs.
3) Type of plan.
There are many types of plans to consider. The type of plan you choose will relate to your coverage in and outside of your network. Always check with a health insurance professional (or healthcare.gov) before making the final decision about your plan. Here are some types of plans you may want to consider:
- Healthcare Maintenance Organization (HMO). This type of plan usually limits coverage to care from doctors who work for (or contract with) the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Exclusive Provider Organization (EPO). This is a plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
- Preferred Provider Organization (PPO). This plan contracts with medical providers (such as hospitals and doctors) to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
- Point of Service (POS). With this plan you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. This plan also requires you to get a referral from your primary care doctor in order to see a specialist.
For more information on choosing the right type of plan, click here.
All marketplace insurance plans cover the basic essentials such as doctor visits, hospitalizations, prescription drugs, etc. However you may want to look into benefits that apply to pre-existing conditions or additional needs. You may want additional coverage for things such as dental, mental health, or pregnancy. Make sure your plan has everything that you need!
5) Special Enrollment.
You may qualify for a Special Enrollment period and be able to take advantage of healthcare credits if you have had changes in your life such as:
- Getting married
- Having a baby
- Losing job-related health insurance
- Adopting a child
- A death in the family
- Moving outside of your coverage area
- Changes in income
- Getting divorced and losing health insurance
To find out if you qualify for a special enrollment period, visit: https://www.healthcare.gov/screener/
As with many things in life, health insurance is not one size fits all. Make sure you consider what services you will need, how you want to receive them, and how often you visit your care provider.