Navigating Health Insurance: An Overview of What To Know When Selecting A Plan
No one is excited to buy health insurance but when a medical emergency happens, you’re glad that you have it. But navigating the health insurance landscape can be confusing, with myriad plans, complex terminology, and countless considerations. Here, we explain the basics of health insurance, provide a roadmap to selecting the right plan, and how Tikkun Patient Advocates can help in the process.
Health insurance is a contract between you and your insurance company. You agree to pay a premium, and in return, the insurance company agrees to pay a portion of your medical costs. This contract is encapsulated in a policy that details what types of healthcare services are covered and to what extent. There’s three key terms define the structure of most health insurance plans that you should be aware of:
Premium: This is your monthly payment to the insurance company to keep your policy active.
Deductible: This is the amount you must pay out-of-pocket before your insurance begins to cover costs.
Co-payment and Co-insurance: These are your share of costs for a covered healthcare service or prescription after the deductible has been paid.
Typically, a plan with lower premiums will have higher deductibles and co-payments/co-insurance, and vice versa.
There’s so many health insurance plans because we all have different health needs. Choosing the right health insurance plan for yourself starts with knowing your unique health needs and also your financial situation because health insurance, and receiving medical treatment, could be very expensive – if you want to learn about excessive medical costs patients face and some tips on how to avoid and alleviate them, I suggest reading my previous blog series on financial toxicity. Here are some steps to consider when selecting your health insurance:
Assess Your Healthcare Needs: Consider your past healthcare usage, including regular doctor visits, prescriptions, and possible future medical events. If you frequently need medical care, a plan with a higher premium but lower deductible may be more cost-effective.
Review the Network: Health insurance plans have networks of providers, including doctors and hospitals. Ensure your preferred providers are in-network, as out-of-network services can be more expensive.
Compare Costs: Beyond premiums, consider out-of-pocket costs like deductibles, co-payments, and co-insurance. Look for a balance that suits your budget and healthcare needs.
Consider Plan Types: From Health Maintenance Organizations (HMOs) to Preferred Provider Organizations (PPOs), different plan types offer varying levels of choice and cost-sharing.
If you're overwhelmed by health insurance complexities, you’re not alone and Tikkun Patient Advocates is here to help. We provide expertise and guidance so you can make an informed decision about appropriate coverage for you and your family and teach you how to maximize those benefits so you get the healthcare you deserve. If you need an ally in your healthcare journey, we’d love to hear from you.