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A Guide to Choosing Your First Health Care Plan 

For many people, approaching the age of 26 means preparing to make important health care decisions. It’s a time when young adults must quickly learn how to manage their health journey independently, from choosing a fitting insurance plan to finding a team of doctors. Though navigating the health care space may seem confusing, there are a variety of resources to help individuals understand the process and make informed decisions along the way. Those approaching 26 can start by learning the basics: when and how to choose a health care plan.

When to Enroll

Health care coverage can be provided through the health insurance marketplace or an employer. Under both circumstances, it’s important to prepare for enrollment to avoid a lapse in coverage. Young adults whose family are covered by the marketplace are able to stay on their plan until Dec. 31, regardless of birthdate. Employer-provided insurance plans expire for 26-year-olds on a family plan during their birth month.

How to Enroll

Those looking to enroll in a health care plan can do so online, in-person or by phone. Many companies provide full-time employees with elective health insurance, so young adults in this position should contact an HR representative to learn more about their options. Those who don’t qualify can select an income-based plan through the marketplace or purchase a policy directly from an insurance company. It’s also important for active students to explore if they qualify for insurance through their school.

Choosing A Health Care Plan

Because there are a variety of health care plans to choose from, it’s important to research coverage options to determine what fits specific health care needs, budget and lifestyle. Many individuals opt for either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). The primary differences between these plans is cost and access to services and health care providers.

HMO: with this plan, physicians, hospitals and other medical professionals care for a patient. Whether it’s a routine checkup, immunization or treatment for illness/injury, the starting point for a patient enrolled in an HMO is with his or her primary care physician. This doctor is responsible for managing all the care a patient receives, including preventive services and referrals to see specialists, such as a dermatologist or podiatrist. It’s important to note that HMOs limit their coverage to in-network care, or a specific service area.

PPO: this health insurance plan does not require an individual’s primary care doctor to manage his or her care plan. Referrals are not necessary to see specialists and oftentimes, members are able to receive out-of-network coverage. In-network care means full coverage with little to no copay. Out of network means limited coverage with higher out-of-pocket costs.

Managing a Health Care Plan

Once enrolled in a health care plan, it’s important to establish an open line of communication with your health care team, regularly schedule wellness visits and identify/manage the risk for chronic illness. It’s also important to keep in mind open enrollment, which is a window of time designated for individuals to sign up, adjust or switch their health care plan each year.

The individual open enrollment period for 2019, for example, began Thursday, Nov. 1 and will close Saturday, Dec. 15, 2018. Open enrollment is important for all people to remember, but especially for those just embarking on their health care journey and still learning their individual health care needs.

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Photo credit: mapodile

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