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How to Buy Health Insurance Like a Pro

Oct 14, 2022
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Buying health insurance probably isn’t among the more exciting purchases you’ll ever make. But like it or not, it’s one of the most important each year. So, we want to help you get it right.

When you start shopping for health insurance, likely the first thing you’ll check is the price, or monthly premium. This makes sense, but just like buying a car or a house, price doesn’t tell the whole story.

You might think of the premium—the monthly charge for coverage—as a “sticker price.” But that’s only the beginning of what you’ll pay because most plans include co-pays, co-insurance and deductibles, which all add up to how much you pay out-of-pocket annually. You can learn more about those costs here.

It’s important to understand the benefits you’ll use because they directly impact how much you might pay to reach an annual maximum out-of-pocket limit, when insurance takes over and pays all your costs. Generally, the less you pay for insurance, the higher your deductible—and the more you’ll pay out-of-pocket as you use more services. So, knowing what you might need will help you limit out-of-pocket costs and maximize your benefits.

You’ll also want to understand types of coverage and be sure your carrier offers a comprehensive network. For example, an “HMO” which stands for health maintenance organization; gives you access to preferred providers; but you’ll need to stay in-network to get coverage. A second popular option, a “PPO,” or preferred provider organization, costs more but affords the freedom to use out-of-network providers at a slightly higher price.

Within each type of plan, deductible costs are designated by Bronze levels, which cost the least, and Silver, Gold and Platinum levels which cost more, but have lower deductibles. You can learn more about those levels here.

As you compare plans, you’ll get information about costs and coverages, but you’ll also see which plans offer services like wellness programs, dental or eye exams, or chronic care programs to support you along the way. Unique to Health Options, for example, is a care management program that partners with community services to support wellbeing, such as providing transportation to appointments or even meals for someone who is recovering at home.  

You might consider a Silver, Gold or Platinum plan if:

  • You have a chronic condition like asthma, diabetes, coronary artery disease or cancer
  • You have a planned surgery coming up
  • You frequently visit specialists or your primary care physician
  • You are planning to have a baby or have small children
  • You take expensive brand or specialty medications

You might consider a Bronze plan if:

  • You are healthy and take few medications
  • You rarely see a doctor

While costs can weigh heavily when selecting a plan, it’s most important to choose coverage that fits your needs. And you might find help paying for insurance thanks to the recent passage of the 2022 Inflation Reduction Act, which extended Affordable Care Act premium tax credits. To find out if you’re eligible, visit CoverME.gov, Maine’s online Health Insurance Marketplace. For information or to get help choosing a plan, you can also call Member Services at (855) 624-6463.

SEE ALSO

Health insurance metals help people understand the amount of cost-sharing that goes on between the plan holder and the insurance company in any given plan. (Need a refresher on how these costs work? Check out our health insurance lingo blog post here!) 

Remember that the exact amount of cost-sharing can vary from plan to plan. And at each metal level, you’ll pay a different percentage of total yearly costs of your care, while your insurance company will pays the rest. Total costs include premiums, deductibles, and out-of-pocket costs like co-payments and co-insurance.

As a rule, the less the insurance company pays in cost-sharing, the lower the cost of the plan. So, Bronze plans typically have the lowest monthly premium costs and highest costs when you need care. Monthly premium costs generally increase according to metal levels. Silver, Gold, and Platinum cost more each month in premium payments but will have lowers costs when you need care. While your monthly premium price is often the top consideration when purchasing health insurance, it’s important to consider the deductible and cost-sharing as well, since these two factors can impact the total amount of out-of-pocket healthcare costs you might incur in a plan year. The total cost of care is what really matters.

When choosing a plan, you’ll want to think about how much you (and your dependents) are likely to use your insurance coverage. Consider things like how often you see a doctor, what medications you take, and whether you foresee scheduling any elective surgery during the year to come. If you think you’ll use your healthcare plan frequently or have prescription medications you take regularly, you might want to consider a higher metal level that offers lower deductibles and makes your costs easier to predict (like a Gold or Platinum plan). If you don’t expect needing many healthcare services, a lower-premium/higher cost-share plan might be a better fit.

One thing that’s important to know is that ALL Health Options’ plans in ALL metal categories offer $0 cost-share preventive care, including yearly wellness checks. Many plans also offer an array of low-to-no-cost benefits that help offset many healthcare expenses (like wellness visits, prescription benefits, and vaccines), even for people with chronic conditions. All non-HSA plans offer Amwell® urgent care telehealth visits with $0 cost-sharing. So, whether you choose Bronze, Silver, Gold or Platinum, you can find a plan that meets your budget and your needs while giving you peace of mind and helping to keep you and your family healthy.