to Choose a Health Insurance Plan
Harvard study published in the American
Journal of Medicine reports that
62 percent of household bankruptcies filed are due to medical bills. What is
even more alarming is that 78 percent of those households had health insurance.
While the cost of healthcare continues to rise, health insurance plans intended
to control costs have been unable to do so. Since the passage of the Affordable
Care Act, many Americans have needed to learn about a product that is
unfamiliar to them. Below are tips to consider when choosing a health insurance
are several types of plans, and each plan offers a different coverage option.
Health maintenance organizations (HMOs) and exclusive provider organizations
(EPOs) limit the doctors and hospitals that the participant may access under
the plan’s network. There is generally no coverage for an out-of-network
provider. With an HMO, a participant designates the primary care physician
(PCP) and must have a referral to visit a specialist. Preferred provider
organizations (PPOs) and point-of-service (POS) plans offer in- and
out-of-network coverage but the policyholder usually pays a higher amount for
using out-of-network providers. With a POS, a participant must have a referral
to visit an out-of-network provider. A high deductible health plan (HDHP)
generally has lower monthly premiums because all costs accumulate to the much
higher deductible with no copays. In 2014, the minimum deductible requirement
is $1,250 for an individual and $2,500 for a family. An HDHP can be paired with
a health savings account (HSA) or health reimbursement account (HRA) to pay for
the eligible medical costs. A HDHP plan is considered catastrophic incident
insurance rather than traditional insurance with coverage that includes routine
office visits and prescription copays.
individuals usually consider the monthly premium for their health insurance,
they don’t always include the costs associated with the plan benefits.
Policyholders should evaluate their anticipated annual medical needs—including
regular check-ups, office visits, lab work and prescriptions as well as the
cost for each of these—when trying to get an accurate picture of one’s
into the extent of network coverage prior to purchasing a health insurance
plan. Insurance carriers sometimes limit the network to control their costs,
and this affects access to local providers.
Affordable Care Act created guidelines about the cost a participant can incur
with an insurance plan. The maximum out-of-pocket limit for any plan in 2014
can be no more than $6,350 for an individual and $12,700 for a family. In 2015,
the amounts change to $6,600 and $13,200 respectively. Policyholders can reduce
their monthly premium by increasing the deductible, limiting the network to
fewer doctors and hospitals, and adding certain exclusions such as fertility,
bariatric and cosmetic procedures.
the Medical Marketplace
view doctors and other healthcare professionals with a high level of esteem
because they are the experts in relieving the pains that ail us. We have not
been taught to question or consider cost when it comes to our health. Question
an item on a medical bill and you will get lost between the transferred calls
and hold music. Health insurance has done nothing if not mask the true cost of
healthcare because patients are no longer responsible for shouldering the
burden of the majority of the cost. Individuals should demand transparency in
healthcare pricing. Knowing the actual cost of healthcare is the first step to
accomplishing change and controlling the true cost of healthcare.
information is provided with the understanding that the association is not
engaged in rendering specific legal, accounting, or other professional
services. If specific expert assistance is required, the services of a
competent, professional person should be sought.