Baby makes choice from three options

News about rising healthcare premiums, cuts to government subsidies, and the uncertain future of Obamacare may seem like good reasons to wait on choosing a health insurance plan. But that hesitation could end up costing you more in the long run. By assessing your health needs and budget now, you will be better prepared to make health insurance decisions that work for you and your family before December 15, when the healthcare enrollment period ends for most states.

When it comes to deciding how to choose a health insurance plan that’s best for you, one of the first things you probably think about is cost. However, cost should not be the sole basis for choosing medical coverage. Just as important are having the right network of physicians, pharmacies, and hospitals. Making sure that all the elements of your healthcare work together can ensure improved convenience, efficiency, and ultimately reduce overall costs.

1) Metal Levels

Don’t let your current insurance automatically renew. A better deal is probably out there, and it may be a different “metal” than you currently have.

This year, the various levels of insurance—bronze, silver, gold, and platinum—have been turned on their heads. Logic assumes that the premiums for bronze are the lowest and gradually rise to platinum. Not any more. If you are eligible for tax credits (generally individuals making under $48,560 and families of four who make under $100,400) things are very different.

Tax credits are based on the second-lowest silver plan in your area. As premiums went up for the silver plans, the tax credit also increased. For most states, this has created a marketplace where subsidized consumers may be able to purchase a gold plan with a lower deductible and improved benefits for the same price as a silver plan. For some people, the tax credit is enough to cover most—or all—of the premium of a low-cost, high-deductible bronze plan.

Shop carefully to find the best choice for you.

2) Physician Networks

Does the insurance company work with your current primary care physician and any specialists that you see? It’s important to check on this. If your physician or specialists remain out of your insurance company’s network, the payments are higher but, in most cases, still reduced.

3) Hospitals

Just like physician networks, insurance companies have certain hospitals that are included in their networks. Knowing whether or not your nearest facility is included in your insurance company’s network could save you hundreds of dollars in the event of an emergency. Out-of-network charges at a hospital can be steep. But keep in mind that not all doctors at the hospital may be part of the network, so you could still be responsible for higher payments for some services.

It’s also important to understand how your insurance pays independently owned freestanding emergency rooms and urgent care clinics. The two may seem the same, but they have very different meanings to insurance companies. Not all independently owned freestanding emergency rooms and urgent care clinics are included in insurance networks, much to the surprise of patients.

Take the time to find out whether the services you are likely to use in an emergency will be covered by your insurance company.

4) Telehealth

The growth in communication among people via smartphones has reached the physician-patient relationship. Some insurance companies are paying for telehealth—healthcare delivered through smartphones, traditional telephones, and computer screens.

There are more companies offering telehealth (or telemedicine) services directly to consumers in some states. The virtual visits are staffed by licensed medical professionals, and they can diagnose common illnesses such as strep throat, colds, and even the flu. Some states are experimenting with mental health services, as well.

5) Paying for Health Insurance

No matter how you receive health insurance, preparing for healthcare costs can save you money down the road—particularly if you have the opportunity to take advantage of a health savings account (HSA) or a flexible spending account (FSA). These two options are available through employers or health insurance companies. The tax advantages of HSAs and FSAs outweigh the risks, even if you have no major medical expenses on the horizon.

Putting It Together

The key to making a decision about how to choose a health insurance plan is knowing your needs. An insurance agent can help you determine which plan is right for you by reviewing your needs and comparing the plans that meet them—at no cost to you. Get a free quote today by calling us at (800) 304-3414.


HealthMarkets Insurance Agency Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in a health plan.


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