How to Shop for Health Insurance | Step-by-Step Guide

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It’s always a bad idea to rush into buying a health insurance plan without taking your time for research and assessment.

However, the vast insurance market may confuse many people, especially if they don’t have access to health insurance provided by employers. Moreover, picking the wrong coverage may end up costing you money in the long run.

Discover our start-to-finish guide on how to shop for health insurance, including analysis, plan comparisons, and more, in the article below.

RELATED: 4 Different Types Of Health Insurance

 

Step 1: Analyze Your Personal Needs & Whom to Cover

Whether you seek individual or family/group health insurance, it’s critical to analyze and assess your personal needs. Knowing what you need helps you secure the most suitable plan out of the bunch of options on the vast market. Moreover, no health insurance is universal, and your coverage level may differ significantly from others.

To ensure that you are making the right choice, consider your current medical condition, regular prescriptions, physicians you often visit, and any specialty care you might need to determine your ideal protection accordingly.

For instance, a young, healthy person has higher approval rates for standard policies. In contrast, older adults may be qualified for policies designed for seniors rather than being included in family floater health insurance.

 

Step 2: Determine the Coverage You Can Afford

Sorting out finances is another major factor when shopping for anything, not just health insurance alone. Essentially, many insurance experts advise that you need to look at a broader picture when picking a plan other than being overly focused on monthly premiums.

Therefore, you must estimate annual costs and pay attention to additional expenses, such as coinsurance, copayments, and deductibles, since these costs significantly impact your overall financial situation.

The higher the deductibles, the lower the monthly premiums, and vice versa. Additionally, most insurance carriers will work with you to determine your affordability based on the possible annual cost of your care.

In particular, high-deductible and low-premium policies could be the best value for individuals who rarely see doctors or don’t expect to use much care during the year. However, beware that such plans can cause a surge in overall costs when they need care. Conversely, a person who frequently requires extensive care may opt for plans with higher monthly premiums in exchange for lower deductibles, coinsurance, copayments, and possible out-of-pocket costs when catastrophic medical bills come up.

Regardless, all plans provide preventive care and offer to cover some services before you reach your deductibles, so check with your network providers for discounts and more information.

 

Step 3: Choose Your Marketplace or Research Insurer

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Depending on where you live, you may be able to shop for health insurance on federal exchanges or state marketplaces, especially if you are not covered with employer-based health insurance.

To shop for health insurance on the exchange, you will need to open an account on Healthcare.gov and fill out the required information after being directed to your state’s marketplace with your ZIP code. Then, the website will assess your qualification rates before allowing you to browse and compare plans on the marketplace.

Alternatively, private insurance brokers may be a good place for shopping for health insurance if you need more time since the enrollment of government-run exchanges only lasts for a limited time (November through mid-Jan, 2022).

While shopping for a policy through a state’s marketplace or federal exchanges can be free of hassle due to provided instruction, obtaining a plan directly from private carriers requires extra effort. Do your research, read through online reviews, and check the claim settlement ratios are a few ways to help you narrow down the most trustworthy providers with the most comprehensive protection for your specific needs.

 

Step 4: Compare Types of Health Insurance

The most popular health insurance policies you encounter are HMOs, PPOs, EPOs, and POS plans.

Since it’s impossible to predict precise amounts of medical expenses, it’s best to put your personal and family members’ medical needs above all else and meticulously read through the benefit summaries while selecting a network plan.

RELATED: Understanding The Health Insurance Marketplace & Ways to Lower Your Cost

 

Step 5: Look Into Health Plan Networks

With these in-network healthcare plans, your expenses are typically lower due to mutual agreements between healthcare providers and insurance carriers to provide cost-effective care for their plan members.

If you have seen certain doctors and physicians, ensure they are included in the plan you are enrolling in. In contrast, an extensive network allows you to have access to more options when it comes to healthcare.

 

Step 6: Understand Coverage Offers & Benefits

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Understanding what your plan covers helps you avoid confusion in the long term, as each plan may relatively come with distinct benefits and services compared to other plans.

As mentioned earlier, most insurance plans cover a set of ten essential preventive care mandated by the Affordable Care Act (ACA). It should be noted that these essential health benefits are not free, and you may need to pay other supplementary costs as required. Ten essential medical benefits (EHBs) are:

  • Ambulance services
  • Emergency services
  • Hospitalization
  • Maternity, newborn, and pregnancy care
  • Mental health and substance use services
  • Prescription drugs
  • Rehabilitation services
  • Laboratory services
  • Pediatric services
  • Preventive and wellness services

 

On top of it, the types of preventive services you may need largely depend on age, gender, medical history, and family history. The following services for all adults are free of copayment charges, including:

  • Abdominal aortic aneurysm one-time screening (for men aged 66-75 who have smoked)
  • Alcohol misuse screening
  • Aspirin use for adults 50-59 years
  • Blood pressure screening
  • Cholesterol screening for adults with higher risk
  • Colorectal cancer screening for adults 50-75 years
  • Depression screening
  • Diabetes (Type 2) screening for overweight adults aged 40-70 years
  • Diet counseling for adults with risk of chronic disease
  • Fall prevention for adults 65 years and over
  • Hepatitis B screening for those at increased risk
  • Hepatitis C screening for those at increased risk
  • HIV screening.
  • Immunization vaccines
  • Lung cancer screening for adults 55-80 years who are at increased risk for lung cancer due to smoking
  • Obesity screening and counseling
  • Sexually transmitted infection prevention counseling for those with increased risks
  • Statin preventive medication for adults 40-75 years at high risk
  • Syphilis screening for those at increased risk
  • Tobacco use screening
  • Tuberculosis screening for adults at increased risk

 

Step 7: Compare Out-of-Pocket Costs

Out-of-pocket costs are equally important as other additional costs. Overall, all exchanges and insurance carriers should be able to let you know how much you are going to pay out of your pocket.

Regardless, it is worth taking a look at plans with high premiums in exchange for reduced out-of-pocket costs if you are:

  • Seeing a doctor or physician regularly
  • Taking costly prescriptions
  • Pregnant or expecting a baby soon
  • Undergoing surgery soon
  • Diagnosed with a chronic health condition
  • In need of emergency care

 

Step 8: Enroll in the Plan

Now that you have found the perfect plan, it’s time to enroll in the plan! From this step, an insurance broker will be instructed to apply the chosen policy or automatic application process via an online exchange.

These days, the approval waiting process has been relatively shorter due to the introduction of ACA. It means that insurance companies are no longer allowed to turn down or charge you more than expected due to pre-existing health issues.

Once approved, pay your first due premiums, wait for an insurance card in the mail, and you are now ready to roll. Another thing to remember is that you will make the payment directly to the insurance carrier you bought the plan from, not through the exchanges.

 

If you have questions about how to shop for health insurance, please get in touch with us to receive a free consultation. 

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