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We get it: navigating the world of health insurance can be confusing, frustrating, and expensive. But you may also have a family relying on you to not only stay healthy yourself but also to safeguard their long-term health and wellness coverage.
Luckily, the team at Trusted Referral Network is here to shed some light on how to find and select the best health insurance for you and your loved ones. Read on for our five secrets.
1. Determine Your Eligibility
Our first tip for securing the right healthcare plan for your family is figuring out what you’re eligible for, to begin with. If you work for an employer that offers benefits, you may have a pretty straightforward path to eligibility. Still, many other Americans, including the elderly or self-employed, may need to consider other options. You can check out the list below.
Employer Coverage
Employer-sponsored health insurance is still considered a significant incentive for U.S. workers, with 80% saying they’d be more likely to accept a job with benefits than without, even if the job without benefits came with a 30% higher salary. The average employer kicks in about 70% to 80% toward the employee's cost of coverage and will sometimes cover the entire policy for workers with no dependents and a high deductible plan.
If you’re a full-time benefitted employee who, in the blur of onboarding at a new job, quickly signed up for coverage and never looked back, it may be a good idea to thoroughly review your healthcare coverage. It’s an even better idea if you know your family’s grown since you first signed up.
Making Changes to Your Employee Health Plan
If you want to change your health insurance coverage through your employer, you can use open enrollment or a special enrollment period to revise your plan.
Open vs. Special Enrollment Periods
Open enrollment periods are typically held once per year and are announced by your employer. During this time, you can usually seek a consultation with your workplace benefits coordinator to enroll in a new plan or make changes to an existing one. Special enrollment periods may be available if you’ve recently experienced a qualifying life event, such as getting married, divorcing, or having a baby.
Medicare
If you are 65 or older, you’re eligible for Medicare. This federal program may cover much of your medical needs and expenses, and you can begin your signup process up to three months before turning 65.
Medicaid and More
Medicaid and the Children’s Health Insurance Program (CHIP) are programs the U.S. government makes available for people needing free or low-cost health coverage. People whose income is below a certain threshold, as well as people with children, disabilities, or who are pregnant, may also be eligible for one of these programs. NOTE: Medicaid or CHIP may be called something different in your state. To find out what’s available where you live, start here.
Marketplace Coverage
The Health Insurance Marketplace is a platform established under the Affordable Care Act (ACA) to help individuals and families secure affordable health insurance plans when they’re not eligible for employer-paid options or other programs. The Marketplace offers a variety of health insurance plans at different price points and allows for certain tax credits or cost reductions for buyers based on their income level.
Private Insurance Carrier
If you missed the open enrollment period for the Marketplace, options for health insurance or short-term coverage are available year-round through private insurance carriers. Since these offerings can be pricier than what’s available in the Marketplace, we recommend working with a licensed health insurance agent to fully assess and understand your options should you choose this route.
2. Consider Your Family’s Needs
Another key consideration when shopping for health insurance is the type and amount of care you think your family will need. Here it's important to consider any family members' chronic conditions, upcoming surgery or prescriptions, and genetic predispositions that may influence your needs down the road. And remember: even healthy people need general wellness checks and preventative care.
Pre-Existing Conditions
“Pre-existing condition” is a commonly used term in the health insurance field. According to healthcare.gov, a pre-existing condition is a health problem an individual has been diagnosed with before starting their new coverage, including heart disease, diabetes, asthma, cancer, etc. A health insurance provider cannot deny you coverage based on pre-existing conditions, but it’s important to note the exceptions and, if necessary, seek a consultation from a licensed health insurance agent who's well-versed in current regulations.
3. Learn and Compare Your Options
If you’ve ever scanned the endless list of plan options and felt like giving up, we're here for you! The more you know about how to filter your many options, the less overwhelmed you’ll feel. Here are some common decisions you may encounter that, if you put a little thought in now, can help you narrow down your plan-picking priorities:
HMOs vs. PPOs
Choosing between HMOs and PPOs may go a long way in helping you understand and narrow your options to the most practical. In a nutshell: Health Maintenance Organizations (HMOs) tend to be a little less expensive than PPOs. The tradeoff? They also tend to be more restrictive about the providers (physicians, specialists) you can see while seeking coverage. If you choose to see a care provider outside the designated HMO "network," you may be footing the entire bill for it.
Planned Provider Organizations (PPOs), on the other hand, tend to allow more choices and broader networks of allowable care providers. And even if you choose a provider outside your network, your PPO may kick in for some cost-sharing that an HMO wouldn't. The tradeoff? Prepare to pay more for a PPO than you would for an HMO. When choosing between the two, think about whether your family may need specialized care and how much control you'll need when selecting your providers.
Premiums vs. Deductibles
Another common decision to help narrow your health plan options involves understanding the relationship between premiums and deductibles. As a refresher, your premium is the amount you pay each month to maintain your insurance plan. Your deductible is the amount you spend on health services (except for free preventive care) before your insurance company starts paying out.
Generally, the higher the monthly premium you pay, the lower your deductible will likely be when you need to obtain care. This higher premium/lower deductible model may be the best option for you if:
You want to avoid having to pay a hefty amount out of pocket if you have an emergency, or
You (or a family member) have a chronic co n and already know you'll need a lot of care.
The reverse is also true: the lower your monthly premium, the higher the corresponding deductible will likely be when you seek care. Learning the metal tiers — Platinum, Gold, Silver, and Bronze — may help you further understand the relationship between premiums and deductibles.
4. Stay Up-To-Date
Your health insurance coverage should evolve with you and your family. Whether you’re having a baby, considering braces for your favorite awkward adolescent, or seeking mental health services for the first time, dust off your current healthcare plan and consider whether it meets your needs. Think about when your next open enrollment period is coming up and regularly assess how changes to your family or finances may require your healthcare planning to adapt.
5. Call in an Expert
Still feeling confused or like your eyes may be glazing over? That’s okay! Instead of spinning your wheels trying to figure out one of the most complicated systems on earth, why not bring in a professional? When you choose to work with a licensed health insurance agent, you get all of the expertise on your side… with less than half of the homework involved.
A common misconception is that you must pay an insurance agent out of your own pocket. But when you work with a licensed, reputable, well-reviewed agent, you shouldn’t have to pay for more than the costs associated with your health insurance plan, like premiums and deductibles. If you'd like some help choosing an agent, we've got your back.
Want to be a guest blogger with the #TRN Team? We are looking for writers to contribute. Reach out to jo@trustedreferral.org to get started.
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