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Good health is one of the most valuable assets a person could ever have. Without it, one cannot enjoy a life of adventures and happiness. While health cannot be bought, you can take steps to ensure that in case of sickness, you don’t have to dig deep into your pockets on the spot to pay medical bills incurred. This is where a health insurance plan comes in handy.
Nowadays, every imaginable possession a person has can be insured – house, car, jewelry, antiques, you name it. Health is no different. But just like any other insurance plan, the field of health insurance can be complicated and tricky to navigate. “Which plan covers the most expenses?” “What types of illnesses are not covered by Health Insurance Plan A?” “Why is Insurance X cheaper/more expensive than Insurance Y?” These are just some of the questions health insurance buyers want answered. Of course, it is understandable for people to want to have the best possible health insurance plan. But the question is, is getting a high-priced premium plan always the greatest option and the cheap plan only a poor man’s choice?
To begin with, it is important to understand the coverage tier or the “metal categories” of health insurance plans. This determines how you and your provider will share the costs of your health care:
- Bronze: lowest monthly contribution. On average, insurance pays 60% and the client pays 40%
- Silver: moderate monthly contribution. On average, insurance pays 70% and the client 30%
- Gold: high monthly contribution. On average, insurance pays 80% and the client 20%
- Platinum: highest monthly contribution. On average, insurance pays 90% and the client 10%
Next determinant is the types of health insurance plans and networks available. The four most common plan types are:
- Health Maintenance Organization (HMO): coverage of care is limited to doctors and hospitals within their network, except in cases of emergency; requires referral for specialists and procedures; clients who get out-of-network care may have to pay all costs themselves.
- Preferred Provider Organization (PPO): coverage is less expensive when a client chooses care within their network; no referrals required for out-of-network care but with additional cost.
- Exclusive Provider Organization (EPO): coverage of care is limited to doctors and hospitals within their network, except in cases of emergency; no referrals required for out-of-network care, but the client has to pay the full cost.
- Point of Service Plan (POS): combines features of an HMO and PPO where coverage is not limited to in-network doctors and hospitals, but costs less when a client chooses in-network care; requires referrals when out-of-network care is chosen.
To be able to opt for the best health insurance plan, you should assess your and your family’s health care needs and compare options side by side to see which plan is the most suitable not only for your health but also for your financial capacity. Factors such as benefits, limitations, and maximum costs should also be put on the table for careful consideration. Putting all of these components together will help you make an informed decision.