How To Choose a Health Insurance Plan: Step-by-Step Guide

Alice TownsendSeptember 2, 2021

You’ll learn the steps to take when choosing the right health insurance plan and help you thoroughly examine your options. Here are 5 steps to help you.

Step 1: Choose your health plan marketplace

If your job offers health insurance, you can skip this step unless you want to look for an alternative to the plan your employer offers. However, keep in mind that health plans within the marketplace might be priced higher than through your job.

Otherwise, you’ll want to choose a health plan marketplace. Start by heading over to  HealthCare.gov during the open enrollment period and enter your ZIP code. After that, you’ll be directed to the exchange for your state unless there is none. In that case, you can use the federal marketplace.

Optionally, there are health insurance plans available directly through an insurer or on private exchanges. However, when you chose that option, you forego your eligibility for premium tax credits.

Step 2: Compare types of health insurance plans

Next, you’ll want to compare the various types of health insurance plans available.

• POS POS stands for Point of Service, which means you pay a smaller copay when visiting in-network healthcare providers. Patients have a primary care physician who coordinates their care by setting up referrals, etc.
• HMO HMO indicates a Health Maintenance Organization, which means you would need to visit healthcare providers within the network unless you have an emergency.
• EPO EPO stands for an Exclusive Provider Organization. EPO plans cover services only when you visit an in-network healthcare provider. However, your out-of-pocket costs are often lower with EPOs.
• PPO PPO indicates a Preferred Provider Organization, which means that your cost for treatment is less when you see doctors within the network.

When should you choose a POS or HMO?

Since these plans require your primary care physician to coordinate your care from other providers, POS and HMOs are great for taking the guesswork out of choosing specialists. Conversely, if you want the freedom to choose your specialists, you might be happier with a different plan.

How does living in a rural area affect your provider selection?

If you live in a rural area with not many providers to choose from, you might have no choice but to visit providers outside the network. In that case, you might prefer a PPO because out-of-network costs are lower than in other plan types.

HDHP and HAS

A high-deductible Health Plan (HDHP) can refer to any health insurance plan- POS, PPO, EPO, or HMO. With an HDHP, you might have a lower insurance premium, but you might pay more out-of-pocket.

When using an HDHP, you are qualified for an HSA- an account with tax advantages.

Step 3: Compare health plan networks

Remember that you pay less when you see an in-network physician because the insurance company has a contract with the provider that requires them to provide care to network members at a lower cost. If you visit an out-of-network provider, the provider does not have such a contract.

Step 4: Compare out-of-pocket costs

Next, inspect the summary of benefits for the plan you are considering for a detailed overview of out-of-pocket fees for services.

You’ll want to pay attention to the coinsurance, deductibles, and copayments as well. These terms indicate your costs for treatment and your out-of-pocket spending limit.

Typically, plans with lower copays have higher monthly premiums. These plans work well for those who:

• Have frequent doctor’s appointments
• Use higher-priced medications regularly
• Need emergency care often
• Suffer from chronic conditions
• Plan to have surgery soon
• Have small children
• Expect to have a baby soon.

If no one in your family fits the criteria above, you might want to select a plan with lower monthly premiums and higher out-of-pocket costs.

Step 5: Compare benefits

If you have not decided upon a plan yet, your next step is to compare the benefits available from the plans you are considering.

Summary of benefits

When comparing plans, pay attention to the summary of benefits and look at which providers are a part of the plan’s network.

Your family’s healthcare needs

Consider your family’s healthcare needs and history of care so you can make an informed decision.

After these considerations, if you still have not decided upon a plan, consider calling the customer service line for the plans you are considering and asking about:

• Out-of-country options for care
• Medications you take regularly
• Maternity care

Requirements for health insurance you can claim straight away

• You recently transferred to a new policy.
• You have had no break in your coverage.
• The waiting period for your desired service has passed.

Health insurance for H-4 visa holders

H-4 visa holders are not obligated to buy health insurance through the marketplace, but they are not qualified to receive Medicaid or Medicare benefits, either. Since emergencies can happen at any time, H-4 visa holders should purchase a health insurance plan.

This is vital to the H-1B visa holding family member’s status, so ensure you choose a plan that:

• Covers you instantly when you travel outside of your home country
• Covers illnesses and emergencies in the US

If your spouse holds an H-1B visa, they may or may not be able to cover the H-4 visa holding family members. If your spouse can cover you on their insurance, make sure you know everything you need about waiting periods and additional costs related to being an H-4 visa holder.

What is CDHP in health insurance?

CDHP stands for Consumer-directed Health Plan. CDHP is great if you don’t frequently need medical care because they are a flexible way to save for your health care and pay for healthcare services.

Health insurance surcharge for smokers

Legally, insurance companies are allowed to charge up to 50% more for health insurance for smokers. While not all states enforce the law, smokers should read the fine print of any plan.

Final thoughts

Visit your marketplace and look at the plans available.

• Choose between HMO, POS, PPO, and EPO (or one eligible for HAS).
• Exclude plans that do not have your doctor or local doctors within their network.
• Decide which option you prefer- higher premiums with more coverage or vice versa.
• Ensure plans include the type of medical services your family uses most.

The key takeaway is that choosing the right health insurance plan is essential for your family, but you can simplify the process by following the step-by-step guide in this post.