Choosing the best and affordable healthcare plan for yourself and your families is not an easy task as you cannot rush and pick the wrong plan that can be costly. To help you out in your mission of purchasing an affordable healthcare plan in the U.S. here is a step-by-step guide that will prove beneficial, irrespective of where you are purchasing the plan. Choose your Health Plan Marketplace In the U.S health insurance is usually offered through employers and if you are one such people then you simply don't need to use the government health insurance exchanges or marketplaces. If you have an employer-sponsored health plan and still you want an alternative plan in the exchanges but plans in the marketplace are likely to cost a lot more. Simply because employer-sponsored healthcare plans have lower premiums and a portion of employee's insurance premiums is paid by the employers. If you are not receiving health insurance from your employer then shop from your state's public marketplace if available in your state or shop through the federal marketplace to find the lowest premiums. You can visit HealthCare.gov during open enrollment and enter your ZIP code to check the plan available on your state's exchange if there is one otherwise on the federal marketplace. You also have the option to purchase health insurance through a private exchange or directly from an insurer but while choosing these options you won't be eligible for premium tax credits that are income-based discounts on monthly premiums. Compare Different Types of Healthcare Plans
The most common types of healthcare plans available in the U.S. are HMOs, PPOs, EPOs, and POS plans. You can choose any plan out of these that will also determine your out-of-pocket costs as well as the doctors you can see. You should always compare plans before deciding upon a plan and must look for a summary of benefits. With online marketplaces becoming common, you can easily shop and compare for the affordable health plan, as the online marketplace provides all the details related to healthcare plans such as coverage, benefits, and costs. If you are receiving health insurance through an employer you can ask benefits administrator for the plan's summary of benefits. While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title. 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. Health Maintenance Organization plans come with lower out-of-pocket costs and allows you to select a primary care doctor who coordinates your healthcare. In HMO plans you have to stay in-network to get coverage and also require a referral before visiting a specialist. You have less freedom as far as choosing a healthcare provider is concerned. PPO plans come with more flexibility, as you have more healthcare provider options and you also don't require referral for visiting a specialist. Though no referral is required but you have higher out-of-pocket costs. You are not required to stay in-network while receiving healthcare but in-network healthcare is less expensive. EPO plans expect you to stay in-network to receive health coverage except for emergencies and come with less freedom and flexibility as far as choosing healthcare providers is a concern. You don't have to obtain a referral for visiting a specialist and you have lower out-of-pocket costs. Point-of-Service Plan provides you more healthcare provider options and you need to select a primary care doctor for receiving health care and also to obtain a referral before visiting a specialist. Though you are not required to visit in-network doctor but in-network care is less expensive. While comparing these plans you need to pay attention to your and your family's medical needs and select a plan accordingly. You should also consider the amount and type of treatment you have received in the past to be aware of your health that will help you make an informed decision. If you select an HMO or POS plan that requires referral then you should first see a primary care physician before scheduling a medical procedure or visiting a specialist. Because of the referral requirement, you may prefer other plans however, HMO plans tend to be the cheapest and affordable healthcare plan. POS and HMO plans may be a better option for you if you don't mind having a primary care physician, who will manage your healthcare and will also choose a specialist for you. The benefit of having these plans is that you will have less work on your end, as your doctor's staff will handle your medical records and coordinate your visits. If you select a POS plan and pay a visit to the out-of-network doctor then make sure to obtain a prior referral from your doctor to reduce out-of-pocket costs. If you like to choose your own specialist, then you may be happier with a PPO or EPO plan because the EPO plan will keep healthcare costs down as long as you visit in-network doctors, especially if you live in a metro area. PPO plans will best suit you if you live in a remote or rural area having limited access to doctors and healthcare because here you might have to visit out-of-network doctors and medical facilities. Compare Health Plan Networks While choosing an affordable healthcare plan you should not only compare different types of health care plans but should also compare different health plan networks. If you want to purchase a cheap and affordable healthcare plan then you should visit plan's in-network doctor because costs are usually lower, as insurance companies make a contract with in-network providers to serve members of the plan at agreed-upon rates, which is generally affordable. When you visit out-of-network doctors you generally have to pay a higher share of the healthcare cost. If you prefer visiting a doctor of your choice only then you should make sure that your doctor is included in the health plan directories, which you are considering to purchase. You can also directly ask your doctor if they take members of a particular health plan. If you don't have a preferred doctor then you should always select a plan offering a large network of doctors to have more choices. This is much more important if you live in a rural community because you will more likely find a local doctor who takes your plan. You should strictly avoid plans that do not include local in-network doctors and plans to have very few provider options compared to other plans. Compare Out-of-Pocket Costs Out-of-network costs are important to consider and the plan's summary of benefits should clearly mention the amount you have to pay out-of-pocket for services. The federal marketplace website along with other state marketplaces provides costs of these out-of-pocket services allowing you to make an easy comparison. Your aim should be to narrow down choices based on out-of-pocket costs. A healthcare plan with higher monthly premiums and lower out-of-pocket costs may be better for you if:
A plan with lower monthly premiums and higher out-of-pocket costs might be the better choice for you if:
Compare Benefits Taking consideration of all the above-mentioned factors will certainly help you narrowed down to just a few options and to further winnow down, you can check the summary benefits to find a plan that covers a wider scope of services. Some healthcare plans provide better coverage for services like physical therapy, mental health care, and fertility treatments and some plans may have better emergency coverage. Skipping this vital step might lead you to miss out on a plan that is much better suited to you and your family. Once you have zero to a couple of options and some questions are lingering on your mind then you should make a call to the plans' customer service lines to clear your doubts by asking questions like:
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