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 might consider a Bronze plan if:
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.
Knowing what your health care plan can do for you is one important part of maintaining your best health, and your Member ID Card is an excellent place to start. First, at the bottom of your card is the name of your plan. If you have the word “Tiered” in your plan, this means you are part of our tiered provider network option and could save money on provider visits.
Tiered provider networks give consumers a better way to consider the cost of care when choosing care options and therefore save money on healthcare costs. Our tiered network plans reduce cost-sharing for specific benefits and services received from a preferred network provider. Types of providers and services include hospital outpatient services, primary care, urgent care centers, imaging centers, and labs.
Preferred providers and facilities for these plans are noted with a preferred star icon in the Health Options Provider Directory at https://lookup.healthoptions.org/. Please note that some services may not be covered at the preferred service rate when administered in non-preferred settings. Therefore, it is important to visit the specific location listed in the search results to take advantage of the preferred rate.
Preferred locations for hospital outpatient services are limited to outpatient surgery and other outpatient procedures (such as catheterization, joint arthroscopy, or colonoscopy), including anesthesia.
It’s important to note: Even if you have a tiered network plan, you always have the option to visit our standard network providers with a standard co-pay. If you have questions about tiered network plans, contact our Member Services team at (855) 624-6463.
The bottom line is, with our robust NE Network and our new tiered network, you are very well covered!