The question of how to choose the best health insurance policies is slightly difficult to answer. Many people don’t get a significant amount of choice in their policy or in the carrier or company they work with. Health insurance is often obtained through employers and they make the choice for employees. Even when people buy health insurance privately, any company can refuse to cover them, though there is hope of changing this in the future. However, there are people who may have more freedom in choosing plans, like those enrolled in Medicare, and those with extremely good health and no pre-existing conditions, and it is principally to these folks that an answer can be directed.
A few basic types of health insurance policies include those that are structured as health maintenance organizations (HMOs), preferred provider organizations (PPOs) or major medical. Medicare has yet more choices that can be researched like the private fee for service (PFFS) plans. Each of these should be understood so a person can choose the best health insurance policies.
HMO
- Uses a group of contracted providers.
- People pay copayments to see these contractors and need referrals to see network specialists.
- Usually least expensive, assessing copayments for different types of visits and having few deductibles.
- Can be challenging if network is small because it may limit doctors that can be seen.
PPOs
- Work in a similar way to HMOs with network doctors.
- Allow people to see out of network doctors but usually assess high deductibles prior to coverage.
- Availability of network physicians is a major concern because there may not be that many, which means people might always have to make higher payments to see non network physicians.
Major Medical
- Relies on coinsurance payments, usually about 20%.
- May have deductibles that must be met first before coverage applies.
- May set standard medical fees charges, which means patients might pay more than the coinsurance payment.
- Often allows people to choose any doctor they like.
A few other types of health insurance policies don’t cover much, and don’t cover basic health needs. Plans like high deductible insurance only kick in if huge amounts of medical care are required. People may fund health savings account to their limits to meet the deductibles, with some or all of care needed being covered thereafter.
These are the types of policies, but it should be noted that every policy is very different. There are great HMOs with lots of doctors, PPOs that have so few network providers that the insured covers the majority of costs, and high deductible plans that don’t really cover as much they appear to on the surface. A comparison of plans then must take into account what is covered and what is excluded.
People also need to think about health insurance policies in terms of financial and medical need. How well will a plan work if medical conditions develop and a lot of care is needed? What is affordable and what stretches outside of reach? For instance is a deductible for hospitalization too high with one plan and more attractive with the next?
There is always a bit of gamble with insurance when people bank on staying healthy. Even with the best diet, the greatest genetic history and things like youth, people still get seriously ill or injured. It’s hard to prevent significant viruses or bacterial infections, and sometimes other expensive health problems can emerge. This would suggest people plan their insurance on the issue of what they can reasonably afford in an emergency, while also bearing in mind what they can afford to pay in premium costs.
As previously mentioned, this choice may be a relatively luxurious one. Many people do not get a choice and must purchase insurance that provides less coverage than they need but is still better than nothing. Yet even those who can easily gain insurance of their choice may not have the best plan in the world without significant outlay. Most insurers are running an industry for profit and there has been profound increase in insurance premiums and amount most people will pay to get medical care, even with insurance.
