This blog was last updated May 2022
There are several decisions in life that can have a lasting and significant impact on our well-being, our lives, and our financial security. Purchasing health insurance is one such decision. And while it’s not quite as important as getting married or buying a house, it’s still not desirable.
If you’re considering health, dental, and possibly vision insurance coverage for the first time, or now find you have to shop around for your own coverage, understanding how to choose the best plans can be challenging.
And while it is certainly possible to find and buy your own health coverage, for example, it may be much easier to rely on the services of a reputable and experienced health insurance agent, such as JC Lewis Insurance Services.
In addition to knowing and understanding the insurance industry from decades of experience, a trusted agent can help you understand the key factors you should know when choosing health insurance, as well as dental and vision plans.
In fact, there are seven major factors to consider when considering health insurance plans, as well as those for dental and vision insurance coverage.
7 key factors in choosing insurance
While there are probably dozens of questions and concerns when it comes to insurance coverage, when we talk specifically about health insurance, there are seven major factors that are the most relevant and most important.
If you’re an employee, you may be offered some options by your company, and comparing plans and health coverage can be relatively simple.
As an employer looking to offer coverage to employees, deciding between all the dozens of providers and the plans they offer is an often stressful task.
And for individuals who do not have health coverage options with their employers or are self-employed, shopping and deciding on the best medical coverage for themselves and possibly their families can be equally confusing and difficult.
Fortunately, the main factors one should consider when choosing and purchasing health insurance, besides dental and vision plans, the following items are the most important:
1. Types of plans
The health insurance industry in the United States is rather complex. In addition to the more than a dozen major providers that provide coverage in California alone, there are several types of health insurance coverage plans.
Among these, the most common are:
HMO – Health Maintenance Organizations
HMOs usually limit coverage to providers who work or are under contract with the HMOs. These plans will generally not cover out-of-network care except in emergencies or with approved out-of-network referrals in some cases. In addition, many HMOs require members to live or work in their service area to be eligible for coverage.
PPO . Preferred Provider Organizations
Most PPOs contract with health care providers to create a network of participating providers. Unlike a typical HMO, you can take advantage of out-of-network providers, however, you pay less using providers that are part of the plan’s nodes network. Visiting health care providers and out-of-network facilities will incur higher fees.
EPO – Exclusive Provider Organizations
EPO is a type of health insurance plan that is often referred to as a “hybrid” plan and only covers the cost of services from doctors, specialists, and hospitals in its network. EPOs may or may not require referrals from a primary care physician and the premiums are typically higher than those of HMOs, but lower than most PPOs.
point of sale – point of service
according to VeryWellHealth.comPoint-of-sale plans are similar to HMOs but are less restrictive in that, under certain conditions, you are allowed to get out-of-network care as you would with a PPO. Like HMO, many POS plans require you to have a PCP referral for all types of care whether it is on-network or off-network.
HDHP/HAS – High Deductible Health Plans & Health Savings Accounts
HDHP plans have much higher deductibles than most traditional insurance plans, however, their monthly premiums are usually lower. This means, in practice, that any healthcare costs incurred will be higher with HDHP until the tolerability ratio is reached.
HDHP can be combined with an HSA, or Health Savings Account. This account is used for tax-free money for medical bills. HSA-eligible plans must meet specific plan requirements set by the IRS, but are not restricted in terms of the type of managed care they use.
2. Monthly installments
This is the amount you pay for your health insurance each month. In addition to your premium, you usually must pay other costs for your health care, including deductibles, co-pays, and coinsurance — costs that are also known as “out-of-pocket expenses.”
For those individuals who qualify for subsidized coverage through the state’s sanitation market, known as Covered California, it is possible for them to qualify for lower monthly premiums through tax credits.
3. Petty cash
These are health care expenses that are not reimbursed by insurance. Out-of-pocket costs include co-pays, deductibles, and coinsurance for covered services as well as the costs of any other services not covered by a health plan:
- Shared Payments: A fixed amount that a member must pay for a covered healthcare service after paying the deductible.
- Discount (discounts: This is the amount that must be paid for covered health care services before an insurance plan begins to pay. After the deductible is paid, usually only co-payments or coinsurance for covered services are needed and the insurance company pays the rest.
- Co-insurance: The percentage of covered health care service costs that the member pays after paying the withholding.
4. Prescribing medication Covering medication
This coverage is the amount your health insurance or plan pays for prescription drugs and medications. Most plans offer some degree of coverage to help pay for drugs and medications, and all plans included in Covered California are prescription drugs.
This aspect of any health plan is more important if you or a loved one requires ongoing medication due to health problems.
5. Health savings account eligibility
Most people, especially those with families, will get better services through traditional health insurance plans such as HMOs or HMOs. However, a particular individual may be able to save significant amounts of money over time by choosing an HSA.
according to article From Investopedia,
“The main advantage of a Health Savings Account (HSA) for many people is the ability to save on taxes. An HSA is a tax-preferred account, which means that HSA holders have certain types of tax benefits. For example, you can claim a deduction on your tax return for contributions Your HSA regardless of whether you itemize your deductions.You can also claim a tax deduction if someone other than your employer makes a contribution to HSA.
To be eligible for an HSA, you must meet the following requirements, as defined by the IRS:
- It must be covered under a habilitation The High Deductible Health Plan (HDHP) on the first day of the month.
- You have no other health coverage except as permitted by the IRS.
- You are not enrolled in Medicare, TRICARE, or TRICARE for Life.
- It cannot be claimed that you are dependent on someone else’s tax return.
- You have not received a Veterans Affairs (VA) benefit for the past three months, except for preventive care. If you have a VA disability rating, this exception does not apply.
- You do not have a Health Care Flexible Spending (FSA) or Health Compensation (HRA) account. Alternative plan designs, such as the limited-purpose FSA or HRA, may be permitted.
6. Service Provider Network
An insurance plan’s network consists of facilities, service providers, and suppliers that the health insurer or plan has contracted to provide a variety of covered health care services. A particular plan network is the basis for the terms “in-network” and “out-of-network” when referring to specific health care providers.
While some plans have relatively small networks and limited geographic coverage, others have nationwide networks and consist of many contract participants.
7. Additional benefits
Aside from basic healthcare provisions, many plans operate to provide additional benefits may include Such as wellness programs, gym membership discounts, free counseling sessions, legal advice, and intuitive online portals for tracking claims, scheduling appointments, and even talking with healthcare providers through video chat tools.
The most important factor in choosing health, dental and vision insurance
Regardless of whether you are an individual who needs to purchase insurance for yourself or your family, or you are a small business owner who wants to offer group coverage options to your employees, unless you are already in business, this is a complex process.
What is inescapable is the fact that there are a variety of options and options when it comes to medical, dental, and optical coverage. It can be difficult to navigate.
This is why working with an experienced local health insurance agent such as JC Lewis Insurance Service can be your best alternative.
according to 1 articleAnd the
“Only licensed agents can legally recommend specific plans to you based on your personal needs and budget. That’s because agents are specially trained and licensed by the state to help consumers.”
Additionally, experienced agents can help both individuals and small business owners compare plan rates and coverage details, explain unfamiliar features or terms, discuss tax benefits, and even make recommendations.
For individuals and families, an agent can help determine if they qualify for premium benefits available through Covered California.
In addition, an independent agent can advise clients regarding options for dental and vision insurance plans.
Your local resource for a California health insurance professional
JC Lewis Insurance is located in beautiful Santa Rosa in Sonoma County, near the heart of Wind Country. We offer California health insurance plans only from leading health insurance companies licensed to do business in California for more than four decades.
In addition to being expert health insurance agents and brokers, we are licensed and approved by every insurance company to offer coverage to individuals, families, employers in small groups, as well as seniors for complementary and prescription drug plans.
Not every small business is required to offer health insurance options to employees, and if your employer doesn’t offer health benefits, purchasing an individual or family plan may be the best option for you and your family.
If you are a small business owner and want to offer health insurance options to your employees, we are ready to help and answer any questions you may have.
It’s also important to note that in California health insurance plans are categorized as “on-disbursement” versus “off-exchange.” This means that buying a plan “on exchange” refers to purchasing a plan directly through the Covered California state health insurance exchange. Purchasing a plan “out of exchange” refers to enrolling in a plan directly through the insurance company.
We invite you to contact us today for more information or request a quote online