Choosing an Insurance Plan

Insurance1Even before I got married, I had my own insurance through my job. Choosing which insurance option was right for me was difficult enough without having to make the best choice for a family. Although some employers may not offer more than two plans, usually those plans have extra options.

What are the primary plan types?

HMO- This is a health maintenance organization. This plan allows you to use physicians who are part of their network. With this type of plan in addition to your monthly premium, you may have a co-pay for office and hospital visits.

Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals. The range of services covered varies in HMOs, so it is important to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis.

PPO- This is a preferred provider organization. This type of healthcare insurance has physicians who are part of their network but also allows you to see physicians who are not included in the network at a higher out-of-pocket cost. PPOs usually require co-pays for office visits, and may require precertification (insurance pre-approval) for some procedures.

What is an HSA?

An HSA is a healthcare savings account. This is usually an option with health insurance coverage that allows the member to put a set amount of money per month (or biweekly) into a savings account. Usually with this type of plan, members are given what looks like a debit card to use the funds that are in the account to pay for their out-of-pocket expenses. This account can be great but also a little confusing. The money put into the account is tax free. This means that it is taken out of your paycheck before taxes are. However, money put into this account that is not used is usually not able to be refunded to you. Deciding how much to put in (which has to be decided when insurance is signed up for) is the most difficult part of this task. In general, putting in at least half of the overall deductible is acceptable. However, if you foresee hospitalizations (for births, surgery) or have high pharmaceutical costs, saving the full amount of the deductible or more may be in your best interest.

There is so much information here, where do I start?

Insurance2Before making the decision, make sure your primary care physician (PCP) (and any other physicians your family may use on a regular basis) is covered by the plan you choose. Most employers provide websites with the plan information to verify that your doctors are covered under the plans.

If the plan(s) offered do not cover your PCP, it may be in your best interest to use a different doctor. Although this is sometimes hard, and heartbreaking, your wallet will thank you. Using a physician who is outside of the insurance company’s “network” would raise what you pay out of pocket.

It is also important to read everything about the plan. Are vision and dental included, or do they cost extra on top of the monthly premium? This is important and easily overlooked. The most important thing is that if you have questions, ask. Call the insurance company, speak with your company’s HR, and talk to others who may have had that plan before.

Although choosing an insurance plan is difficult, it is important to choose one that will cover the needs of your family. The last thing any parent wants to think about when they have a sick child is whether or not their insurance covers the illness or injury. It is always good to be prepared and understand how your plan works for you.

“For I will restore health unto thee, and I will heal thee of thy wounds, saith the LORD…” Jeremiah 30:17

By Sarah J. Ancheta

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