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Health insurance has become a virtual necessity in today's economy - and a legal requirement. The question is not so much whether to get health coverage but which type of policy to purchase. But how do you know which policy is right for you?
There are numerous factors to consider when making this kind of decision. You have to connect the dots between your health needs and each potential policy's strengths and weaknesses - while keeping everything down to a reasonable cost.
A health insurance agent can guide you through each feature in a detailed way to ensure you make a choice you won't regret. But here are four basic areas to keep in mind even as you prepare to speak to an agent.
1. Choose The Right Deductible
There are three types of health insurance in regard to deductibles: high deductible, low deductible, and no deductible. Each has its purpose and advantages.
High deductible policies are good because they will have lower premiums. So long as you have enough money in an HSA or other savings account to pay your deductible (if necessary) and are unlikely to spend a lot on healthcare in the coming year - a high-deductible policy can be a wise choice
Low deductible policies may cost a little more as to monthly premiums, but cost-sharing begins earlier too. These are better for those who expect to have substantial health expenses. A no-deductible policy is similar but may cost even more - but with cost-sharing beginning immediately.
2. Select Your Coverage Level
For marketplace plans, the coverage level is represented by a "metal." Bronze plans cover 60% of qualifying healthcare expenses, silver plans cover 70%, gold plans 80%, and platinum plans 90%. Thus, your coinsurance gets lower as the insurer's payment responsibility rises.
Non-marketplace plans may not be described by the metals system, but the same principle applies. And copays, set amounts you must pay for doctor's visits, ER visits, urgent care, etc.tend to go up or down along with the coinsurance percentages.
Thus, coverage level is as critical as deductible when it comes to gauging how much your health insurance would pay versus leave you paying under a specific scenario.
3. Does It Have An Out-of-pocket Maximum?
Another feature that some policies offer is called an out of pocket maximum. This number is the most you will possibly have to pay for your share of covered health expenses during a year.
So, for example, let's say your deductible is $1,000, coverage level is gold, and out of pocket maximum is $5,000. You have $10,000 in covered healthcare costs that year. Thus, you pay the first $1,000 in full, 20% of the next $9,000, but not over $5,000 no matter what. You would pay $1,800 out of pocket under this scenario.
If you had $100,000 in expenses, you would pay only $5,000 instead of $19,800 because of the out-of-pocket cap.
4. Good Prescription Drug Coverage
Another area not to neglect when formulating and customizing your health insurance plan is prescription drug coverage.
Most policies will offer at least some coverage for prescription drugs, but you need to find out how much. And find out if you can get a big boost in coverage by opting for generic-brand equivalents.
The multifaceted nature of health insurance makes it wise to get the advice of an expert before making a final decision. Contact Summerlin Benefits Consulting to speak to one for free today!