Considerations when choosing health insurance

Health insurance is vital in the modern world. Some countries provide universal health care to residents, but the United States is not among them. As a result, Americans must navigate the health care system carefully, particularly when choosing their own insurance plans. Even professionals whose companies offer employer-sponsored insurance may need to choose between options within those plans. As individuals and families consider their health insurance options, they may want to keep these factors in mind. Open enrollment period: Changing health insurance plans may only be allowed during specifio periods, notably at the time of hire, after a major life change (marriage or birth of a child) or during a period known as open enrollment. Typically open enrollment starts in November and runs through January.

Employer or state insurance marketplace: Many employers offer health insurance to workers. and employees will be limited to the plans available. Those who do not get health insurance through an employer or people who simply want to see other options can shop their state’s online marketplace or the federal marketplace to find a plan.

Health insurance also can be purchased directly from an insurer or through a private exchange, but the costs may be higher.

Alphabet soup: Insurance jargon can be complicated and consumers will come across various abbreviations alluding to different offerings. Health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO) and point of service plan (POS) are some types of coverage. Generally speaking, plans that require in-network doctors and referrals have lower out-of-pocket costs buť less freedom to choose providers.

Claim denial rate: It may be wise to research particular health insurance companies to learn the percentage of insurance claims that are denied and how long appeal processes can take.

Identify all the costs: A health insurance premium is the cost of the coverage, regardless of services used. This is the amount that an employer, employee, or a combination will pay each pay period. Copayments are fixed fees for certain kinds of office visits, other services and prescriptions due at the time of service. A deductible is the cost paid (after premiums) for services before insurance kicks in. Healthy individuals who do not visit the doctor often may want a higher deductible plan which could have lower premiums.

Coinsurance may be another cost required on certain services to make up for what insurance doesn’t cover. For instance, many plans pay 80 percent and then the individual is responsible for the remaining 20 percent. Plans also have out-ofpocket maximums that, once hit, would cover all future costs. Each of these costs merits consideration.

Medication coverage. Make sure the health insurance plan covers the medications needed. Create a list of medications and note if brand name prescription drugs or generics are covered.

If prescriptions are primarily generic, you may be able to choose from a wider array of plans.

Health insurance considerations are numerous. Wading through the information helps consumers make wise choices.