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What Level of Health Insurance Do You Need? 5 Key Questions

What Level of Health Insurance Do You Need? 5 Key QuestionsHow can you decide what level of health insurance to get? Answer the key questions in this article get the guidance you seek!

Running between October 15 and December 7, the annual open enrollment period is now well underway. And, the chances are that you are in the stressful process of purchasing, renewing, or upgrading your health insurance policy.

But this certainly isn’t a decision to be made in a rush or under pressure! After all, the insurance policy you choose will determine the level of care you’ll be able to access in months to come.

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So, how can you decide with confidence what health insurance to get? Answering the questions below can offer you the guidance you have been looking for!

Do You Rely on In-Network Facilities and Doctors?

One of the critical considerations to make before choosing medical insurance is whether you rely on in-network facilities and doctors for your everyday healthcare. And, in most cases, if you have a healthcare provider you already trust and respect, the best option is to choose a policy that will cover the services provided by a particular clinic.

In terms of coverage levels, don’t forget that PPO (preferred provider organization) and EPO (exclusive provider organization) policies don’t typically cover the services provided by out-of-network providers. If accessing in-network services is important to you, opt for HMO (health maintenance organization) or POS (point of service plan) plans instead.

How Do Health Insurance Plans Compare? 

While there has never been so much choice in terms of insurance providers and policies, not all healthcare insurance plans are created equal. That is why comparing health insurance policies is one of the critical steps to take to find a suitable plan for your medical and financial needs!

When comparing health plans, there are a few things to keep in mind:

  • There are 4 “metal” categories (Bronze, Silver, Gold, and Platinum) which will determine how comprehensive and expensive your plan will be.
  • Insurance plans are divided into four categories (HMO, PPO, POS, and EPO), each of which has its own pros and cons in terms of network reach, copays, and premium costs.
  • Lower premiums mean higher deductibles. Make sure to choose the most convenient option according to your health status, age, and pre-existing conditions.

Do You Have Specific Needs or Pre-Existing Conditions?

Conditions and diseases such as heart disease, diabetes, mental disorders, epilepsy, obesity, and HIV affect over 51% of the US population. But, despite how common these conditions are, chronic and pre-existing conditions might still have an unexpected effect on your health insurance eligibility.

That is why, if you have one or more of the conditions below, you should look for an ad hoc insurance policy that will provide coverage for specialist visits, services, and prescription medications. Some options to customize your policy include investing in additional coverage for your employer-sponsored plan, opting for Medicare Advantage plans, and handpicking riders.

Does Your Employer Offer Health Insurance?

According to statistics by the Kaiser Family Foundation, employer-sponsored health insurance plans provide coverage for around 155 million nonelderly people in the US. so, if you are employed, the chances are that you will be able to take advantage of affordable or free health insurance for you and your family.

Nonetheless, it is important to consider that employer-sponsored plans are often standard and designed to only cover essential care needs. So, even if your employer offers health insurance coverage, you might look into the benefits of tailoring your coverage to your needs through add-ons or supplemental insurance.

Are You Eligible for Medicare?

The introduction of programs such as Medicare has helped millions of people across the US access high-quality coverage for medically-necessary healthcare services. In turn, one of the key questions to ask yourself is whether you qualify for Medicare.

Generally, this is an accessible option for individuals aged 65 and over or for people with disabilities. Depending on whether you are eligible for Part A or Part B, you will be able to take advantage of free or discounted services such as inpatient hospital care, prescription drugs, surgery, and home health care.

If you wish to access more specialist services (such as vision, hearing, or dental visits) you might consider the benefits of investing in supplemental coverage or Medicare Advantage plans.

Bottom Line on Health Insurance

If you are unsure about the best type of plan for your needs, a consultation with your healthcare provider or insurance broker can help you better understand how to best meet your medical needs.

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