Your health is way too important to leave to chance. That’s why it’s critical that you have health insurance and that it is the right fit for you and your family. Unfortunately, millions of Americans do not know if their health insurance plan will cover their needs—or how to secure better coverage.
A good health insurance plan—one that covers every potential need—goes a long way toward providing peace of mind and helping avoid a financial burden that otherwise would saddle you and your family with payment of major medical expenses. Ideally, you should have a more comprehensive plan that provides coverage for hospital, surgical or routine medical expenses. But, at minimum, your health insurance policy should cover major medical expenses resulting from catastrophic illness or injury.
Many Americans secure health insurance through their employer; others are not so lucky. But even if you have a primary policy, be aware that group benefit plans do not always provide all the coverage for your needs. You may want supplemental insurance or a health savings account (HSA) to help fill the gaps.
For those purchasing their own primary or secondary health insurance policy, the options can seem confusing and expensive. So, how do you know if your health plan is a good fit for you? Here are some tips:
- Evaluate your family’s needs. Consider your
family’s lifestyleand medical history, and try to anticipate life-stage health events, such as braces for your pre-teen and glasses for your self. Wife turning40? That means mammograms every year.
- Prioritize those needs. For example, vision care may be a good benefit for your family, but not as essential as a prescription-drug plan. List your must-haves as well as
- Review plan options. For each plan you are considering,
ask aboutkey coverage provisions: Does the policy cover major medical expensesonly? If your family needs preventive, dental and vision care, does the plan provide them? Does it include a prescription drug plan? Do anyof these must-haves need to be purchased separately? Are your currentdoctors in the plan? Does a family member have a pre-existing conditionand will the plan cover it?
- Determine your costs. Premiums are not the only costs
you shouldconsider when looking at a health insurance plan. Take into accountthe expenses you may have to assume beyond paying the premium, such as deductibles, coinsurance andco-payments. Are there added costs forusing an out-of-plan doctor or hospital? Consider increasing your deductiblefor a lower monthly premium.
- Consider an HSA or FSA. An HSA provides two benefits: a
tax write-offand a health coverage benefit. The health benefit provides coveragewhen you are sick or injured and the savings mechanism allows youto accumulate funds that you can use to pay for care for illnesses orinjuries not covered by your insurance. An added benefit of an HSA is thatboth the cost of the health plan and your contributions are tax-deductible. Similarly, a Flexible Spending Account (FSA) allows you toset aside pre-tax dollars to cover medical expenses, which can help loweryour taxes.
- Know the differences
ofPPOs & HMOs. Individuals in a health maintenance organization (HMO) must choose a primary-care physicianfrom a provider network. This physician is responsible for routinemedical care and must refer you to specialists. HMOs typically provideno coverage for services from physicians outside the network. Meanwhile, individuals in preferred provider organizations (PPO) do not choosea primary care doctor and do not need referrals. They can obtain coveragefrom physicians outside the network but the PPO likely will reimburseless for the services. PPOs require deductibles and co-payments; HMOs don’t have deductibles but participants must pay co-payments. Again, be sure your family’s doctors are in the plan you select.
- Get coverage today. Health insurance, much like
life insurance, is usually less expensive for younger people. So, get your coveragenow to secure a lower premium and be sure to maintain your coverage.
- Use it. Use your insurance for preventive care and
wellness todecrease your risk of needing more serious medical treatment. Schedule routine doctor visits and getthe regular tests that physicians advisefor your age and condition. Take advantage of the discounts offeredby some plans for gyms and weight-loss programs. Seek help for smokingor alcohol abuse.
- Don’t let it lapse. If you lose or leave your job, you may
be eligibleto take advantage of a COBRA plan. Even though you’ll be footingthe whole bill for your health insurance, you’ll be getting the employer’sgroup rate and retaining coverage for 18 months. If you go withoutinsurance for more than 60 days, it can be trickier and more expensiveto purchase health insurance down the road.
- Stay current. Coverage can be affected by life’s changes—
if youget married or divorced, for example. And keep in mind that your childrenwill not be covered by your plan indefinitely.