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7 Guidelines for Choosing a Health Insurance Policy

by Amarachukwu
7 Guidelines for Choosing a Health Insurance Policy

Purchasing health insurance is a significant undertaking. However, as anybody who has attempted to choose a new health insurance plan will tell you, the process may be quite difficult. With information, price, and rules continually changing, determining what kind of plan you need may be difficult.


Despite the fact that it is a distinct and unique undertaking, there are a few things that every prospective health insurance buyer should consider while shopping for a new plan.


Our health demands, as well as the coverage possibilities of health insurance, might alter from year to year. As a result, it is critical to understand your health-care alternatives in order to choose coverage that meets your requirements and budget.


This is the period of year when consumers may choose or alter their health insurance plan for the next year. This is now possible for over 13 million individuals in New York and millions more around the nation.


Here are 7 Tips to Choose a Health Insurance Plan that will provide you greater health and more expenditure savings in 2022 to help you make the most of open enrollment this winter.


Examine the prescription medication coverage provided by each health insurance plan.


If you are presently taking prescription medications, you should extensively investigate each prospective new plan to discover which prescriptions are covered. This may be accomplished by obtaining the insurer’s “forms” or lists of covered pharmaceuticals. Typically, insurers maintain a classified list of medicines organized into tiers.


According to Dr. Michael Bihari of Very Well Health, generic medications often have the lowest copay expenses, but brand-name prescription prescriptions are likely to cost more. This implies that you should read the small print of any possible insurance plan carefully, since some insurers may require patients to take lower-level medications before moving on to brand-name pharmaceuticals.


Examine and compare the features, services, and prices of every plan accessible to you, whether you’re searching for a new plan or determining how well your existing plan matches your requirements. Then you may choose the one that works best for you. Before you can begin, you must first understand a number of words related to health insurance. Premium, deductible, copayment, coinsurance, and out-of-pocket maximums are examples of these phrases. Check out our brief reference guide to help you comprehend the words.


If you are eligible for Medicare, be sure you grasp the difference between Original Medicare and Medicare Advantage while weighing your alternatives. If necessary, go to MedicareMadeClear.com, an online resource that provides answers to concerns regarding eligibility, plan alternatives, cost fundamentals, prescription coverage, and more.


Knowing how to get the most out of your prescription coverage will help you keep your spending under control. For example, seek low-cost options, such as discounts, generic medications, and so on.


You may also save money by filling your medicines at a participating network pharmacy or by using home delivery by mail.


Those with Medicare may be startled to hear that Original Medicare does not often cover prescription medicines. To help keep your medication expenditures under control, consider joining Part D or a Medicare Advantage plan with prescription drug coverage.


Check to see whether the providers you want are in-network.


Do you have a good relationship with your present doctors? Then you must determine if they will stay in-network if your health plan changes. If you don’t already have a doctor, you may go through the list of in-network providers in your possible new plan. Then, call the new doctor to inquire about typical patient care hours, if you would be seeing new patients, and to get their credentials. 


This way, you’ll know exactly what you’re getting into before you make the switch. You may always take a step further and seek information from a clinician via the American Medical Association (AMA). If you have a particular ailment that necessitates seeing a specialist, ensure that there is a specialist in the new network that you also like and trust.

Consider if you want to contribute to a health savings account.

Some individuals like putting money into a health savings account, sometimes known as an HSA. An HSA is a personal savings account that may be used to pay for medical costs. An HSA might be appropriate for practically anybody, including those who are young and healthy and want to save money for a medical emergency, as well as those who are approaching retirement and want to offset some expenditures. 

According to the Mayo Clinic, you may withdraw money from an HSA for non-medical reasons whenever you need to before the age of 65. However, HSAs have limitations.


According to US News and World Report, individuals may contribute up to $3,500 in tax-deductible contributions to an HSA in 2019, while families can contribute up to $7,000 tax-free. Those over the age of 55 may contribute an extra $1,000 to catch up.


Only some plans, however, enable users to make donations, so if you wish to add one, make sure your new plan fits the criteria. According to US News & World Report, only high-deductible health insurance plans are allowed to contribute to an HSA.


In 2019, eligible plans have deductibles of $1,350 and out-of-pocket maximums of $6,750 for single-person coverage. Family plans offer a higher minimum deductible of $2,700 and a significantly greater out-of-pocket maximum of $13,500.

7 Guidelines for Choosing a Health Insurance Policy7 Guidelines for Choosing a Health Insurance Policy

Examine your income to discover whether you are eligible for tax credits.


Yes, health insurance might be costly, but the government can assist. The IRS provides a “premium tax credit,” which is defined as a “refundable tax credit meant to assist qualifying low- or moderate-income people and families in purchasing health insurance via the Health Insurance Marketplace, generally known as the Exchange.”


The amount of tax credit a person gets is determined on their income. According to the IRS, people with a lesser income get a greater credit to help pay the cost of insurance, and those with a higher income may only receive a little credit, if any at all.


Don’t worry; if you decide to enroll in health insurance via the Exchange, you may ask the Exchange to generate an estimated credit for you. This credit might subsequently be applied to your insurance provider, lowering your monthly cost. Of course, you may opt to get that money as a credit when you complete your tax return.


So, who gets the glory? On the other hand, it is a little perplexing. “In general, individuals and families may be eligible for the premium tax credit if their household income for the year is at least 100% but no more than 400% of the federal poverty threshold for their family size,” the IRS notes.


While this figure is subject to change, in 2017 a single individual earning between $12,060 (the poverty level) and $48,240 (400 percent over the poverty line) qualified for a loan, while a family of four earning between $24,600 and $98,400 qualified.


Remember to consider the deductible as well as the premium.


Yes, it’s easy to experience sticker shock when it comes to monthly premiums (the amount you must pay each month to have your health insurance), but it’s also important to consider the plan’s deductible (the amount you must pay before your insurance company will pay a claim).


According to Norris, a typically healthy individual may be good with a high deductible but cheap premium plan since that individual may never need to utilize insurance for emergency purposes. However, someone who is already dealing with a health issue, like cancer, may choose a higher deductible but lower premium plan.


This is because a person with cancer will almost certainly hit their deductible regardless of what occurs, but they may save a little money by paying a reduced premium instead.


Those in the center, with modest health-care expenditures such as surgery or medical charges, are the ones who must do the job.


“They are typically better served by one of the medium-term strategies,” Norris added. “They really need to delve deeper and tailor their strategy to their own scenario.” I usually tell folks to consider the entire premiums they will pay over the course of the year, as well as the total of their out-of-pocket expenditures.


Then, compute the worst-case scenario and examine your total out-of-pocket expenditures in a middle-of-the-road scenario. and then devise a strategy.”


Look for any further advantages.


Health insurance isn’t only for emergencies. Many plans and providers also give wellness programs and incentives to their members in order to keep them healthy and out of the doctor’s office.


Perks might include gym memberships, transportation to medical visits, free therapy sessions, video chats with physicians at any time, and even legal advice, according to US News & World Report.


Consider a plan that offers 24/7 virtual care if you’re juggling children’s schedules and job duties, traveling, or just want to communicate with a doctor from the comfort of your own home.


These visits are intended to be a more convenient and cost-effective method to speak with physicians about common health issues while utilizing a smartphone, tablet, or computer.


Members with private, employer-sponsored, and Medicare Advantage plans are often able to receive virtual care, which may enable access to a variety of treatments, including wellness care, regular care, and urgent and chronic illness management.


Ask for assistance if you need it.


If all of this seems daunting, that’s because it is. But that’s OK since there are those that can assist you. Norris said that among them are insurance brokers in their town.


“When shopping for a new health insurance plan, I believe the first thing to do is ask yourself, ‘Am I comfortable doing this on my own?'” Norris said. “If you don’t, and many people don’t, I believe getting assistance is a terrific starting step.” This way, you receive assistance from someone who has done it many, many, many times before.”

Final Thoughts


Additional benefits, like dental, vision, hearing, or critical illness insurance, are often offered to protect you and your family while also contributing to your general well-being.


For Medicare beneficiaries: While Original Medicare does not cover prescription medicines or the majority of dental, vision, and hearing treatments, many Medicare Advantage plans do.


Open enrollment normally happens between September and December for those who obtain coverage via their employment. 


From October 15 through December 7, anyone eligible for Medicare may enroll or make modifications to their coverage. Changes made on these dates will be effective for the majority of individuals on January 1, 2022.


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