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Your Step-by-Step Guide to Choosing a Health Insurance Plan

Your Step-by-Step Guide to Choosing a Health Insurance Plan

If you are not covered by your employer and need a comprehensive and affordable family insurance plan, you have to act fast. The residents of California can participate in health insurance schemes under the Covered California and Affordable Care Act. You can choose the best policy and compare the cost and the features amongst the providers to give you the most affordable health care.

Comparing Californian health care plans

There are many types of plans available in the market, and you have to scrutinize them very well to find the one most suited to your needs.

PPO or the Preferred Provider Organization is a health plan that comprises of a network of the health care providers but also provides a comprehensive coverage if you look for medical care outside the preferred network. You do not need referrals from a PCP or a primary care physician before you visit specialists. These are possibly the most expensive health care plans in the market today.

HMO or Health Maintenance Organization provides access to a set network of physicians that consider charging a lower rate for exclusive rights in the scheme. Some of these plans are not providing coverage for treatment availed outside the system. It would help if you were careful about that. They might alternately pay less if your treatment is done outside the specific network. You need to get approval for specialized care from a PCP. 

The POS or point of service plan is a sophisticated mixture of both the PPO and HMO plans. Your in-network PCP can give you a referral and allow you to get treated by an out of network specialist.

The EPO or exclusive provider organization is a service, as the name suggests. You get coverage only for networked services. It is a cheaper plan but more restrictive. It may suit you, but do check the network once before signing up.

All the plans are available with positive and negative points. You must see what suits your age, affordability, and family structure the best.

It is crucial to compare out of pocket costs

You have decided on the health care plan you want to buy and are about to make a decision. It is also essential to consider the out of pocket expenses that are needed to cover all your medical costs. Lower premiums also mean higher out of pocket expenses and vice versa. 

You should go for higher premiums if you are more likely to need frequent treatment. There are extra payments for co-payments, coinsurance, and deductibles.

You can choose a cheaper plan if you are healthy and do not need frequent hospital visits, but in the following cases, you do need a policy that gives you extra coverage. 

  • You have a chronic problem like diabetes, cancer, and such that needs frequent treatment from a physician or a specialist.
  • It would be best if you had emergency care very often.
  • You have a condition that needs expensive medication regularly.
  • You are planning to add to your family and have children.
  • Your family comprises of young children or older adults who need routine medical care.

Once these choices narrow your scope, you need to look at the fine print as medical insurance can be the difference between the right treatment and high out of pocket costs. Some plans are useful if you require care for chronic diseases, some are better if you need mental health services and so on. Look for insurance providers that give you a better choice with your required needs. These pre-checks may be an excellent way to make the best choice in a vast sea of confusion.

You must choose carefully as health care is expensive, and you may have trouble if you need treatment that is not covered by your health insurance provider. It is better to take time to scour the marketplace before choosing. The plan that suits another family might not be the best one for you.

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