5 Questions to Ask When Enrolling In a Health Plan

Whether you’re choosing your own health insurance for the first time or looking to renew, choosing a plan can be tough. After all, there are a lot of choices out there. Blue Cross Blue Shield of Michigan and Blue Care Network alone offered more than 40 individual health insurance plans in 2015. It’s great to have so many options, but how do you choose?

Here are five questions that might help:

What type of network is it?

There are three main types of networks you’ll likely see when choosing health insurance: PPO, HMO and EPO.  Each of these networks have physicians, hospitals and other health care professionals that agree to provide medical services at pre-negotiated prices and rates for Blues members. Here’s how they’re different:

  • A Preferred Provider Organization (PPO) network gives individuals and families the freedom to receive covered services from an “in-network” (PPO) provider or “out-of-network” providers. You’ll pay less if you go to an in-network provider.
  • An Exclusive Provider Organization (EPO) network covers services only from a provider within the EPO network, except for emergencies and accidental injuries.
  • A Health Maintenance Organization (HMO) is a more limited network of providers. You must select a doctor to coordinate your care and provide you with referrals if necessary. Services outside of the HMO network are typically not covered, except for emergencies.

All health plans have a summary of benefits and coverage that clearly indicate the network. If you’re shopping for individual or family insurance through the Health Insurance Marketplace, you can find this information on HealthCare.gov. You can also visit the health insurance company’s website, or call the company directly.

Is my doctor in the plan’s network?

If you have a doctor you’re happy with, make sure your doctor participates in your health plan’s network. Providers may not accept all health plans, so it’s important to check with your doctor and your health plan before enrolling in health coverage. You can visit bcbsm.com/find-a-doctor to see if your doctor is in your plan.

What services does this health plan cover?

All health plans offered on the Health Insurance Marketplace are required to have 10 essential health benefits. Plans may offer additional coverage – such as dental and vision benefits for adults – and you may have health needs that require specific services or coverage. Make sure you choose a plan that best fits your needs.

All plans have a summary of benefits and coverage that outline what services are covered. If you’re shopping for individual or family insurance through the Health Insurance Marketplace, you can find this information on HealthCare.gov. You can also visit the health insurance company’s website, or call the company directly.

How much will my health plan cost?

How much you pay for your health plan will depend on your individual situation and what health plan you pick. Health plans vary by level: catastrophic, bronze, silver, gold and platinum. Catastrophic and bronze plans have the lowest monthly premiums. But your share of costs for medical care is highest. You will pay higher monthly premiums for a silver, gold or platinum plan, but your share of costs is lower. When selecting a level, understanding how you will use your health plan and how often you will seek care is important.

Am I eligible for lower costs on the Marketplace?

Depending on household income and other factors, individuals and families may qualify for financial help on the Marketplace (HealthCare.gov). Before you select a new health plan, make sure you find out if you’ll receive lower costs. Text “Subsidy” to 222-752 or visit bcbsm.com/subsidy to see if you qualify for savings.

 

For more health insurance tips visit bcbsm.com/101 or follow the hashtag #Covered101 on our social channels. If you have a specific question, please submit your query online through our Customer Action Center

Photo Credit: U.S. Department of Education

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