How to Win The Health Insurance Contest


Medical costs are the most common cause of bankruptcy in the U.S. as if needing medical care wasn’t catastrophic enough, so it’s no wonder that so many people are looking for ways to lower their health insurance price without taking too much risk. With insurance plans changing constantly, it’s hard to keep up and monitor the whole situation, though, especially if you’re not an expert in the field. What should you know to make sure that you get the best option there is in the health insurance market?

Step 1: Marketplace

The best place to start shopping for insurance is your employer. Most of them provide their workers with a plan to buy and very often it’s cheaper than anything you can find on your own – that’s because your employer agrees to cover some it. If this plan doesn’t meet all of your needs or maybe your job doesn’t provide it at all, you can always find something by yourself. Here you have two option: your state’s public marketplace if there exists one, or a federal marketplace. There are lots of private insurers as well, and you can find some good option there, but you have to bear in mind that if you go for a private health insurance plan, you won’t get premium tax credits (discounts on your premiums based on your income).

Step 2: Types

There are many different types of insurance plans, but several of them are more popular than others: 

  • HMOs – you have a primary doctor who coordinates you, the costs are lower, but there aren’t too many choices for you to make when it comes to choosing your specialists, 
  • PPOs – the costs are higher, but no referrals are required, so the process is quicker, and you have more options, 
  • EPOs – you get lower costs and no referrals are required, but you have very little choice, 
  • POS – you have a primary doctor, many choices, but referrals are required. 

It probably doesn’t tell you anything, so it’s best to do thorough research before deciding anything – compare all possible costs (not only monthly premiums), benefits, the lists of doctors and clinics available with each plan and procedures (e.g. in the case of medicare reimbursement, sometimes your medical bills go from your doctor directly to your insurer, but other times you need to pay and file a claim by yourself later). Think about what you and your family really need – consider your age, life situation and medical history. If you choose a plan in which you need referrals, you may pay less, but you always have to remember to go to your primary doctor before seeing any specialist or you’ll be charged a lot. With any health insurance plan, there are doctors who agreed to work in-network, so they have lower rates. If you have your favourite doctors, it’s best to check if they’re in-network and choose a plan that they’ve chosen to avoid lots of additional costs of seeing an out-of-network specialist.

Step 3: Costs

A lot of people compare only the monthly premiums of a plan, but there are also different costs to calculate if you aim at finding the best health insurance plan. You need to see each plan’s out-of-pocket expenses – deductibles, copayments and coinsurance. Each plan should provide information about the maximum possible amount you can spend out-of-pocket. The higher the premiums, the lower your out-of-pocket costs – you may want to pay a little more monthly if:

  • you see some specialist regularly,
  • you in need of surgery soon,
  • you have any chronic condition,
  • you tend to need emergency care a lot,
  • you need prescription drugs on a regular basis,
  • you have children or you plan on having them in the near future.

Step 4: Benefits

Very often the plans may seem the same when it comes to their premium and out-of-pocket costs, but they offer different kinds of benefits, so you have to know what you need – do you prefer to have emergencies covered or maybe you need mental health care or physical therapy? It’s an important issue to think about and discuss with your family, as a well-chosen plan can help you reduce your healthcare costs significantly. Some plans may cover your prescription drugs, maternity services or emergencies that happen abroad – which of these are you most likely to need in the nearest future?

Remember that you don’t have to do it all on your own. There are customer service lines and specialists that are willing to help you choose the best plan, very often for free. So if you feel lost and overwhelmed by the number of possible options, maybe it’s best to ask for help. Choosing your health insurance plan is not a decision that should be made fast and lightly, so make sure you know absolutely everything before signing up for anything.