Whether you get your health insurance from an employer or you buy it as an individual, it’s the time of year to re-evaluate your plan options. With so many options for insurance nowadays, it can be an overwhelming choice. How do you know which one is right for you? How can you get the most value?
For starters, there are three main things to consider when choosing a plan: overall cost, provider network and benefits.
The monthly cost of your health plan (the “premium”) is important, but simply choosing the lowest monthly price might end up being more expensive in the long run. The more you pay per month, the less you will pay when you go to the doctor for care. To fully understand overall costs, it’s important that you know the five costs that make up a health plan, and how they factor into what you pay throughout the benefit year.
If you’re relatively healthy, a low monthly cost might be a good option. If you have a chronic condition or tend to need a lot of health services, you might want to get a plan that costs more per month in order to pay less out of pocket each time you need care.
Type of plan and provider network
Health plans are generally categorized by an acronym like HMO, PPO, POS or EPO. All of these plans have a network of doctors, hospitals, pharmacies and other health care professionals that agree to provide medical services at pre-negotiated prices and rates for BCBSM and BCN members. The biggest difference between types of plans is how you interact with those networks.
For example, HMOs only cover health care services given by doctors and hospitals within the plan’s network. To go to a specialist, you need a referral from your primary doctor. With a PPO, you can see doctors, hospitals and specialists in or out of your network without a referral, though you’ll pay more for out-of-network doctors.
When you’re up for your plan renewal, think about what doctors you saw in the last year:
- If you only saw your primary doctor, an HMO might be a great way to save money.
- If you have several specialists, like a dermatologist or chiropractor, you might want the flexibility of a PPO.
- If you rarely travel and are extremely price-sensitive, see if you have an EPO plan option. With an EPO, you can only receive care within a small, localized network of doctors and hospitals. You’ll pay the full price of any care received out of that network.
Before finalizing your plan choice, make sure you check to make sure your current doctor and preferred hospital are within the plan’s network.
All Blue Cross plans cover the set of 10 essential health benefits outlined by the Affordable Care Act. These include doctor visits, hospitalization, mental health services, prescription drugs and more. When evaluating your options, compare what each plan covers. How much will it cost if you have to go to urgent care? If you have a specific disease or disorder, will the plan cover the services you’ll need?
Once you’ve settled on the right plan for your health and financial needs, here are some more tips for maximizing the value of your health insurance plan:
- If you have a high-deductible plan, consider pairing it with a health spending account that lets you use pre-tax dollars to pay for medical costs.
- Use the Find a Doctor tool to select your primary doctor, if you don’t already have one. Consider choosing a doctor that’s part of a patient-centered medical home (PCMH). PCMH doctors provide extra benefits like extended hours, 24-hour phone access and streamlined care coordination.
- Avoid the unpleasant surprise of unanticipated costs by knowing what’s covered before going to the doctor. If your doctor recommends a test, procedure or medications ask these questions to ensure you’re making the best choice.
- Minimize your health care costs with these six tips, like getting the recommended doctor appointments.
- Register for an online account. If the insurer offers it, use it. Bcbsm.com makes it easy for BCBSM and BCN members to manage their health insurance online. Not only can members review billing information, like medical claims, deductible levels and copays, but they also have benefits like digital health coaching, online podcasts, and self-health articles covering a number of different conditions
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: Juhan Sonin