| 6
Tips for Choosing the Best Type of Health
Plan for Your Budget |
Nationwide, many
businesses are heading into their fall health plan
enrollment period, when employees have the opportunity
to choose a new health insurance plan for the coming
year. But many people still find themselves confused
when it comes to the nitty-gritty of choosing the
best health coverage.

"Health insurance
is a hot-button issue because of the rising costs,
the personal impact health has on our quality of life
and the confusing alphabet soup of acronyms the industry
uses," says Brad Stroh, co-CEO of Bills.com. "These
three factors make it stressful for most of us to
try to make decisions about our health insurance.
Because of its impact, it is especially important
for people to educate themselves about health care
and make good choices for their well-being."
According to the
Urban Institute, low-income adults who have employer-sponsored
insurance but have high health costs spend 10 percent
of their income on health costs above and beyond premiums.
People without a group insurance policy spend twice
as much.
Stroh offers the
following 6 tips to select the right health insurance:
1. Do your homework.
Learn about different
types of health insurance plans to find out what kind
of coverage is best for you and your family. Ask your
employer's human resources office for information,
and search online – a good starting place is
Bills.com's dedicated health
insurance page.
2. Get with the
plan.
About 60 percent
of Americans are covered by employer-sponsored health
plans. If you can join a group plan through your employer
or your spouse's, you'll usually find it more affordable
and easier than purchasing individual insurance. For
some small companies, however, their groups become
too expensive – for example, if several members
have high-risk births or expensive treatments like
cancer or transplants – and the employers turn
to individual coverage. Still others don't qualify
for group insurance and must choose individual insurance.
Review all your options to find the best one.
3. Learn your
ABCs.
There are four
basic types of health insurance plans. In simple terms,
this is what they are:
-
HMO: The health maintenance organization, or HMO,
usually charges lower monthly premiums in exchange
for making a restricted network of providers available.
In most communities, the networks include many of
the physicians and hospitals you might choose anyway.
These plans also cover preventive care such as annual
checkups. If you go outside the network, though,
you won't be covered.
-
PPO: The preferred provider network, or PPO,
also uses a network approach to limit costs –
but out-of-network expenses are covered, albeit
at a lower rate. Premiums are slightly higher than
with an HMO, and preventive care might not be covered.
-
FFS: Fee-for-service (FFS) coverage refers to
"old-fashioned" health insurance where the doctor
bills for individual services and the health insurance
pays for services it has specified, at a pre-determined
rate. You might have to pay out of pocket and be
reimbursed. Some services will be covered, and others
not at all, depending on the contract.
-
HSA/MSA: Health savings accounts (HSAs) or medical
savings accounts (MSAs) are newer options that accompany
high-deductible plans. Patients pay lower premiums
in exchange for higher deductibles. What services
are covered will depend on the plan, but members
will pay more out of pocket up to a point. Members
can, however, save pre-tax dollars in an HSA, from
which they can pay medical bills as they arise –
or save the money for later if it's not needed.
4. Crunch the
numbers. Try to compare options, apples to apples,
to understand what your costs could be. A pricier
HMO plan that combines low co-payments, covered treatment
for a child – from wellness to winter colds
– and covered prescriptions might pay off. A
high-deductible plan's lower premiums look good, but
does your cash flow allow enough flexibility to pay
for a $500 procedure if needed during the year? Estimate
your anticipated costs over a full year with each
health insurance option, including premiums, doctor's
office visit co-payments, prescription costs, alternative
care such as massage and chiropractic and other care,
such as mental health care, that one plan might cover
while another does not.
5. Consider quality.
Review health plan materials to see how many providers
are board-certified and how many participating facilities
are highly rated. Ask friends and family about their
experiences with the insurer and its providers. If
you have favorite physicians, make sure they are part
of the health plan network. You can even call your
physician's billing office and ask them which plans
are known to be good about paying claims promptly
– a trait that will help your bottom line and
keep you in the billing office's good graces.
6. Take a psych
test. Consider how each plan will work with your own
personality. Do you have the self-discipline to put
funds in your HSA? If not, you might find yourself
saddled with unanticipated bills for medical care.
Would you feel more comfortable knowing everything
is covered? Then you might be happy with a restricted
network in exchange for the security of an HMO. Understanding
your comfort level will help you make the right choice.
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