Navigating Medical Insurance: A Guide To Choosing The Right Plan

Choosing medical insurance can be a tricky process, but there are a few key things to consider. Firstly, make sure the plan you choose will pay for your regular and necessary care, like prescriptions and specialists. Secondly, consider the type of plan you need - HMOs, PPOs, EPOs and POS plans are the most common types of health insurance policies. Look at the amount and type of treatment you’ve received in the past and consider whether you want higher premiums with more health coverage, or lower premiums and higher upfront costs.

Ensure the plan covers necessary care like prescriptions and specialists

When choosing a health insurance plan, it's important to make sure you're getting the coverage you need. Look at the amount and type of treatment you’ve received in the past. While it’s impossible to predict every medical expense, paying attention to trends can help you make an informed decision.

Make sure the plan you choose will pay for your regular and necessary care, like prescriptions and specialists. Don’t forget to discontinue your old plan, if you have one, before the new one starts. Go to your online health insurance marketplace (or employee benefits page) and view all of your plan options. Decide what type of plan — HMO, PPO, EPO or POS — is best for you and your family. Weigh whether you want higher premiums with more health coverage, or lower premiums and higher upfront costs (potentially HSA-eligible). Eliminate plans that don't include your preferred doctor or that don't have local doctors in their provider network.

Online marketplaces usually provide a link to the summary of benefits, which explains all the plan's costs and coverages. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Evaluate past medical expenses to predict future costs

When choosing medical insurance, it's important to evaluate your past medical expenses to predict future costs. This is because trends in medical expenses can help you make an informed decision.

To do this, you should look at the amount and type of treatment you’ve received in the past. This will give you an idea of what types of treatments you may need in the future and how much they may cost.

You should also consider your current health status and any ongoing medical conditions you have. This will help you understand the likelihood of future medical expenses and the potential costs associated with them.

Additionally, it's important to review your past insurance claims and bills to see what has been covered and what hasn't. This will give you an idea of what types of treatments and services are important to you and how much you may need to pay out of pocket in the future.

By evaluating your past medical expenses, you can make a more informed decision when choosing medical insurance. This will help you select a plan that provides adequate coverage for your needs and budget.

Choose between HMO, PPO, EPO or POS plans

When choosing a health insurance plan, it's important to make sure you're getting the coverage you need. The most common types of health insurance policies are HMOs, PPOs, EPOs and POS plans.

HMO stands for health maintenance organization. This is named for the overall goal of this kind of plan — which is to help maintain your health. With an HMO, or health maintenance organization plan, you pick one PCP under your plan's network who provides routine care and refers you to in-network specialists for additional care. HMOs will not cover out-of-network care.

PPO stands for preferred provider organization. The name refers to its network of contracted PPO providers. With this type of plan, there are preferred providers who can offer care at the lowest out-of-pocket cost (compared to out-of-network providers). EPO stands for exclusive provider organization. This refers to the rule of this type of plan that requires members to get care within the plan’s network of select providers. If you get care outside the EPO network, you’ll likely have to pay the full cost of that visit.

POS stands for a point-of-service plan. With this type of plan, each time you need health care (the time or “point” of service), you can decide to choose network care and allow your primary care physician to manage your care, or you can decide to go outside of the network and seek care from a doctor of your choosing.

If your doctor’s already in-network, or you’re flexible about where you get care and can easily stay in-network, then choosing an HMO or EPO may mean a lower cost for you each month. If you need the freedom to go outside a narrow network and still get some benefits from your coverage, then look at PPOs or a more flexible POS plan.

Check if your preferred doctor is included in the plan

When choosing medical insurance, it's important to check if your preferred doctor is included in the plan. Online marketplaces usually provide a link to the summary of benefits, which explains all the plan's costs and coverages. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available.

If you're going through an employer, ask your workplace benefits administrator for the summary of benefits. This will help you understand what kind of plan you have and what it covers.

Eliminate plans that don't include your preferred doctor or that don't have local doctors in their provider network. This will ensure that you have access to the care you need and that your regular and necessary care, like prescriptions and specialists, are covered.

It's also important to consider the amount and type of treatment you’ve received in the past. While it’s impossible to predict every medical expense, paying attention to trends can help you make an informed decision.

Finally, make sure the plan you choose will pay for your regular and necessary care, like prescriptions and specialists. This will ensure that you have access to the care you need and that your health is covered.

Review the plan's costs and coverage in the summary of benefits

When choosing medical insurance, it's important to review the plan's costs and coverage in the summary of benefits. This document explains all the plan's costs and coverages and is usually available on online marketplaces. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

The summary of benefits will outline the amount and type of treatment you’ve received in the past, which can help you make an informed decision. It will also detail the plan you choose will pay for your regular and necessary care, like prescriptions and specialists.

The summary of benefits will also outline the most common types of health insurance policies, which are HMOs, PPOs, EPOs and POS plans. What you choose will help determine your out-of-pocket costs and which doctors you can see.

It's important to make sure you're getting the coverage you need and to discontinue your old plan, if you have one, before the new one starts.

When choosing medical insurance, it's important to review the plan's costs and coverage in the summary of benefits. This document explains all the plan's costs and coverages and is usually available on online marketplaces. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Frequently asked questions