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9 Essential Things to Keep in Mind when Choosing a Health Plan

In the market for a new health plan?

It’s the time of year when people start shopping in the Affordable Care Act marketplace for a health plan for next year. Since 2010, the ACA has changed the way Americans get health insurance. But the ever-changing American health insurance landscape can make it hard to figure out how to choose a health care plan.

This guide will make choosing a health plan much easier for you. Keep reading, and keep these essential things in mind as you make your choice for health insurance coverage!

1. Prescription Coverage

If you take prescription medicines, this is one of the most important things to keep in mind as you choose the best medical insurance plan for you.

You’ll be able to check with the insurance provider to see which medicines are covered by their plan, and which aren’t. If your medications aren’t covered by the plan you choose, you’ll end up paying much more or go through a complex process to get them covered.

Shop with a list of the medications you need by your side. As you check which insurance plans cover them, also check what your copays will be.

2. Plan Network

Every health insurance plan has its own “network” of providers. Seeing a doctor or healthcare provider who’s in the network will cost less for you. That’s because the insurance companies contract rates with the providers in your network to get lower rates for both you and the company.

You might already have providers who you love. If you’re attached to your current providers, make sure to find a health plan network that they’re in.

But if you don’t yet have providers that you regularly see, you’re better off choosing a plan with the biggest possible network. That way, you won’t have to struggle to find an in-network provider near you when you need care.

3. Total Costs

It’s important to weigh your total costs when deciding between plans.

You’ll see four different categories of plans as you shop: bronze, silver, gold, and platinum. These “levels” refer to the way the costs are divided between you and the plan.

Each month, you’ll pay a premium to the insurance company. This is a flat rate that you have to pay whether you received health care services that month or not. But when you do get health care, you’ll also need to pay the out-of-pocket “deductible” amount.

Make sure to weigh both your premium and deductible amounts when choosing your healthcare plan. Otherwise, you might end up with a plan that you can’t keep up with financially.

Along with the cost of premiums and deductibles, there might also be a coinsurance or copay cost before you can get care. These are flat fees you have to pay before you can get services or medications.

4. Medical Specialists

If you have certain conditions, you might see medical specialists for the treatment you need. Make sure to find out if you can see specialists under the plan you choose – if they’re in the network or not.

Some plans will require you to see a primary care physician before you’re covered for a specialist visit. But make sure the coverage will be there if you need it.

Reading reviews of an insurance plan can help you see how hard it might be to see a specialist under that plan – see more reviews here.

5. Benefits

The benefits refer to the services that are actually covered by your plan. The more benefits or services you get with a plan, the better.

Of course, there will probably be some listed benefits that you don’t need right now. But you might need them in the future, so it’s best to have them available if you can.

6. Emergency Care

Not all of your healthcare needs can be met with regularly scheduled doctor visits. Sometimes, there will be a need for emergency visits to the hospital. Your health insurance plan affects those situations, too.

You can check with providers for the list of hospitals and emergency rooms that are covered under the plan. You’ll also need to check to see what qualifies as an “emergency” according to the provider. Some of the things that you think merit a trip to the ER might not actually be covered by your plan.

7. Pre-Existing Conditions

Are the conditions you already have covered? Make sure your pre-existing conditions don’t exclude coverage according to the insurance provider.

You can check the exclusions list of the plan you’re looking at to see what is and isn’t covered. If any of your existing conditions is on there, you should find a different healthcare plan.

8. Ob-Gyn Coverage

If you (or your wife) need to make regular visits to an ob-gyn, will your current provider be covered under your new healthcare plan?

You should also check for coverage of any specialty treatments you might eventually seek out, like fertility treatments. If you are or plan to get pregnant in the future, check out what kind of pregnancy coverage is offered. Will you have to pay high out-of-pocket costs for care throughout the pregnancy and birth?

9. Health Screening Coverage

Although the benefits of preventative medicine have been well-established, many insurance plans aren’t focused on prevention. If you plan to get regular checkups or health screenings when there’s nothing wrong, that’s great! But you should work to find a health plan that will cover those visits.

Many plans cover an annual physical, but some of the independent plans may not. You should also make sure any checkups for your children will be covered, as well as vaccinations.

Choosing a Health Plan That Fits You

Choosing a health plan isn’t easy, but the extra work you put into doing this research will pay off. A great health plan keeps you covered through good times and bad, eliminating a major source of stress for many Americans.Once you’ve chosen a great health plan, there are other ways to prepare yourself for future health situations. Check out our guide for finding great medical transport here.

We also recommend reading the guides published on LivelyMe.com. Read through their HSA 101, FAQs and resources to learn more about choosing the right health plan, and managing it efficiently by maximizing your savings.

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