Select Your Insurance Plan with Confidence
Dealing with a monumental health condition can be extremely overwhelming. You are faced with endless decisions while trying to absorb a vast amount of new information and vocabulary. It is vital to understand the steps necessary to make informed decisions about your healthcare. Find the peace of mind you deserve by following this practical guide in selecting the best insurance plan for your needs.
Learn the jargon
To master the process of selecting the right insurance plan, you must understand some common acronyms and vocabulary terms. These terms include distinctions between healthcare plans and basic principles common within each type.
All insurance policies require a fee for coverage, which is usually charged monthly. Premiums vary widely according to the type of plan that is offered. For a majority of those insured through their company, their employer pays half of their premium and you pay the remaining balance. For those lucky enough to have employer-provided coverage, the entire premium is paid. If able to purchase coverage on your own without an employer, premiums are usually fully covered by you.
Many policies will require set fees for office visits and other services. Regulations for co-pays are designated within the policy. Some important co-pays to look for when choosing insurance include doctor and specialist co-pay, medication co-pay, and if it varies by genetic or branded prescriptions. Co-pay shouldn’t be confused with coinsurance.
Most insurance policies are designed to require the subscribers to pay a certain dollar amount of medical costs before benefits are applied in addition to their co-pay. While a co-pay is usually paid before services are rendered, until you reach your deductible, you should expect to be billed for your portion of the procedure. After this deductible is met, the insurance policy will pay a certain set percentage for medical care for the remainder of the year.
The portion you pay of a covered health care service after you’ve reached your annual deductible. Usually, this is listed on comparison paperwork as 20/80 and other such factions to indicate that you will pay 20% of the costs while your insurer will cover 80%. This aspect of insurance can be confusing to many not used to conceptualizing money in this way and may vary by the type of service (ex. hospital versus mental health facility).
Insurance companies often contract with a network of healthcare professionals that will accept negotiated fees for services. In turn, insurance companies will cover the services of these providers at a higher rate than those outside of the network. This can be beneficial if you chose a high deductible plan and are hoping to avoid out-of-pocket fees after co-pays.
Providers who have not contracted with certain insurance companies are referred to as out-of-network. This can be a particularly important part of your policy if you’re someone who prefers to have complete control over who treats you or suffers from conditions in which many providers do not accept insurance. Sometimes companies will cover these services at a higher rate. In other situations, their services may not be covered at all.
Main types of insurance plans
Fee-for-services plans (traditional health insurance plans)
These plans are the least restrictive in nature. The policies will pay for anyone who accepts this type of insurance without few exclusions. This type of insurance tends to be more expensive.
Health Maintenance Organizations (HMOs)
This is a type of managed care that is often offered through an employer or large organization. HMOs usually require subscribers to stay in-network or greatly limit choices outside the network. A primary care doctor coordinates care, which gives less freedom to choose providers.
Point of Service Plans (POSs)
This is a specific type of HMO in which primary care doctors must make referrals. If the referral is outside of the network, a co-pay will be required.
Preferred Provider Plans (PPOs)
This type of plan is a combination of fee-for-service plans and HMOs. A patient may go outside of the network, however, maximum benefits are only received when preferred network providers are used.
Medicare and Medicaid
These federal health insurance programs are for people 65 years of age or older or younger individuals with disabilities or severe Diseases. Medicaid provides health coverage for low-income subscribers and their dependents.
Supplemental insurance policies
Many supplemental medical policies pay a fixed amount for each day a subscriber is in the hospital. The policy outlines the total number of days a policy will pay. The money provided from a supplemental policy may be used for a wide range of expenses, including travel and lodging during treatments. Supplemental plans are designed to extend or support standard insurance plans and should not be relied upon as a primary form of insurance.
Some supplemental insurance policies that are common are long-term and short-term disability insurance. These can be used to cover costs when missing work for extended periods of time and may be able to assist with medical costs behind on what type of disability insurance your employer or insurer provided.
Critical illness and cancer policies are increasingly popular in today’s market as that talking goose becomes a particularly good salesman of supplemental cancer policies. These specialized policies pay benefits for certain kinds of serious health problems such as debilitating accidents, cancer or strokes. They cover expenses excluded from regular health insurance policies. At times, these policies will pay a fixed amount upon diagnosis or injury. This classification of policies must be purchased in advance and include limitations and waiting periods. It is critical to review the details of the policy to avoid disappointments and surprises. They are not designed to cover the majority of healthcare services a patient needs.
Invest time in research
Finding the right insurance coverage can often feel like a full-time job. Look at the time as an investment in your care that will pay large dividends over time.
Review your short and long-term goals for your care and really evaluate your needs. Explore your priorities. Do you value comfort and familiarity or seeking cutting-edge treatments that increase your opportunities for the best outcome? You may need to consider your out-of-network coverage. Are you willing to travel for care? Will your new policy cover that?
The more that you are aware of your own needs and wishes, the more clearly you will make choices that are right for you.
Take advantage of your resources
Find a wealth of resources and comparisons of different types of insurance through such resources as the insurance marketplace website. Ask your primary care physician about ways to discover insurance possibilities that are available to you. Call on trusted family members and friends to help you so that the task is done efficiently and with the benefit of many minds.
Don’t forget to utilize modern tools. Create visuals, whether in Google Sheets or Visme, that allows you to quickly review your data as you collect it. Develop online spreadsheets or grids for a point-by-point analysis.
Look to the experts. Attend seminars and informational sessions offered by local agencies. Find out what is available locally and even globally through online events such as webinars sponsored by Medicare or other reliable sources.
Stay informed and aware of your own history of care. Keep copies of essential medical records in order to improve communication and the quality of the care that you receive. Create a personal health record (PHR) so that medical information from several sources is quickly accessible and easy to communicate.
Basic components of your PHR include:
- Copies of pathology reports
- Copies of imaging test results (CTs or MRIs) that are usually stored digitally
- Copies of operative reports reflective of any surgical procedures
- Discharge summaries for hospital stays
- A comprehensive list of past and present medications including correct names, purposes, dosages and history of use
- Treatment summaries for radiation therapy
- Contact information for all health care providers serving you during your journey. There are many health care providers who compile electronic health records (EHRs). These EHRs are often kept on a secure web portal that may be accessed with login credentials.
By investing time and effort, you are taking charge of your own healthcare journey. This process is both clarifying and empowering.
Clarify by comparing insurance
Once you have clarified your goals and priorities, researched your options and educated yourself on insurance terminology, you are ready to make a careful comparison of the policies available to you. Call on the help of your trusted advisers and spreadsheets or other tools of information to compare deductibles, co-pays, in-network and out-of-network providers, exclusions, waiting periods and other qualifications that are important to your situation.
Thoroughly consider your family’s medical needs, including all expenses. Decide if having a managing physician will lessen stress or will cause you to feel stifled and restricted in your care. If having specific doctors is most important to you, find out the companies that work with these physicians in-network. If you are willing to consider several options, look for a plan with a large network to allow a greater range of choices. Look for a plan’s summary of benefits to determine how much you will be required to pay overall. Quickly eliminate choices that do not meet your needs.
Understanding you are not alone
It is natural to feel isolated and alone when facing a life-changing crisis. Fear and uncertainty are paralyzing emotions. Realize that there are many who have walked this path before, either as a survivor or as a healthcare provider. Gather a heart-warming group of kindred around you, try these techniques:
- Turn to trusted family members and friends. Allow them to be strong for you when you need support. Consider the strengths each of your confidants has and be willing to rely on them as needed. Do you have loved ones who are gifted with organization and analysis? Do you know ones who have the energy to provide encouragement and time? It is essential to share the load so that you can build the best plan possible.
- Look for those who have successfully navigated similar paths before you and draw upon their experiences and wisdom. Ask your inner circle for help in finding those who can provide hope and inspiration for you at this time.
- Talk with a trusted primary care provider. If you do not have a relationship with a primary care physician, ask for recommendations. Find someone who will take the time to listen to you and walk through the journey with you.
Once you have prepared yourself mentally and emotionally by seeking the support you need, you are ready to begin the process of making wise healthcare insurance decisions.
Once you have narrowed your choices down to a few quality options, contact representatives for each of the plans that you are considering. Be ready to discuss details of each policy, including coverage of specific medications, procedures and treatments. Don’t be afraid to ask questions. It’s their job to sell these products to you. Consider how the representatives respond to your questions and their willingness to help you find the answers that you need. If you need help determining if our office carries your provider, don’t hesitate to contact us and discuss in detail what your insurance covers.
Your optimum health journey is within your grasp. With the right support team, tools and knowledge, you are well equipped to make the insurance choices that are right for you.