Here’s how to find the best health plan based on your needs.
Choosing a health plan is an important decision for both your well-being and your wallet. It is critical to consider all of your options as you might not have the opportunity to change it for another year. Plus, finding a health plan you’re happy with will provide comfort and peace of mind.
Before you begin, consider your needs and ask yourself some basic questions. Are you purchasing insurance for yourself, a dependent or your whole family? How often do you typically visit your doctor each year? Do you see specialists? Do you have a chronic condition or medical need that will require attention in the coming year (e.g., pending surgery or maternity needs)?
Your annual household income may also come into play. You may qualify for financial help to lower the cost of health insurance, so it will be helpful to have that information handy. Nine out of 10 enrollees get financial help and many pay $10 or less a month..
With all of this information front and center, here are five key points to consider:
1. Coverage Level
Most plans available through Covered California feature four tiers of coverage: Bronze, Silver, Gold and Platinum. The plans all cover the same set of benefits, but they differ in how you and your insurance company split the cost of that care. For example, Bronze plans feature lower monthly premiums in exchange for higher deductibles and copays, while Platinum plans have higher premiums and lower costs per service. Keep in mind that all health plans in a particular tier (e.g., all Gold plans) follow an identical cost structure, meaning the copays, deductibles and out-of-pocket maximums are all the same. However, plans within the same tier may have different monthly premiums, provider networks and prescription drugs covered.This handy chart can help you navigate your options.
2. Type of Plan
HMO, EPO and PPO plans are among the most common types of health plans available. HMO plans require you to visit health care providers who work for or are under contract with the HMO (except in the case of emergency), and often require you to get a referral from your primary care physician (PCP) to see a specialist. With an EPO plan, you don’t need a referral from your PCP to see a specialist, but you must visit providers that are within your network. A PPO plan has the most flexibility, allowing you to see in-network providers and out-of-network providers for an additional cost. Typically, with health plans, the more flexibility there is, the higher the monthly premiums.
3. Provider Network
Do you want to keep seeing your current primary care physician or specialist? Is there a specific hospital you prefer? Check the directories of in-network health care providers for each plan you’re considering to ensure your preferred doctor is included and confirm it with the provider. The larger the provider network, the more choices you’ll have, but it’s important to know if the in-network doctors are available nearby, especially if you live in a rural area.
4. Essential Health Benefits
Covered California works with many different health insurance companies whose prices and availability vary by location. No matter where you live, all plans available through Covered California offer the same essential health benefits, including emergency care, preventive and wellness services, hospitalization and more. Make sure the plans you’re considering cover your regular care, including prescriptions. If you take a specific medication, take a look at each plan’s prescription drug coverage (often called a “formulary”) to ensure the medication is covered and how much your out-of-pocket cost would be.
5. Total Cost
Get a sense of the total cost of different plans that best fit your needs by using Covered California’s Shop and Compare tool. The straightforward questionnaire will take into account information like your household size, income, location, age, and basic care requirements to recommend plans that might work for you so you can compare monthly premiums and coverage options, as well as the estimated total annual cost with everything included for different plans. This tool will also show you if you and your family qualify for financial help to lower how much you pay for premiums and out-of-pocket expenses.
If you have any questions, free expert help is there when you need it. Now that you know how to choose a plan, start an application through Covered California today.
