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How to Buy Health Insurance Like a Pro

Oct 13, 2023
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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 copays, coinsurance 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 Community Health Options, for example, is a care management program that partners with community services to support well-being, 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 expensive medications
  • You only occasionally see a doctor
  • You can manage the cost of a higher deductible and maximum out-of-pocket expense should you or your family have the need for more care.

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 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.  For quick tips on what to look for, how to get help with, or how to use a health plan, follow @communityhealthoptions on TikTok.

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When it comes to health insurance, the strength of a health plan’s network helps to determine its value, and you want to be sure the care you need is never far away. That’s why Community Health Options’ network stretches across Maine, and includes many providers in New Hampshire, Vermont and even Massachusetts, comprising 48,000 clinicians, hospitals and pharmacies—no matter which plan you choose.

When you buy auto insurance, you really don’t give much thought to who might fix your car if you have an accident, because you’re hoping you never need it. But health insurance is different. You’ll use it no matter what, whether you are healthy and need screenings to stay that way, or need care to manage chronic illness, behavioral health issues or complex care.

So, when it comes to health insurance, the strength of a health plan’s network helps to determine its value, and you want to be sure the care you need is never far away.

That’s why Community Health Options’ network stretches across Maine, and includes many providers in New Hampshire, Vermont and even Massachusetts, comprising 48,000 clinicians, hospitals and pharmacies—no matter which plan you choose. Notably, all Maine hospitals*, most in New Hampshire and Centers of Excellence in Massachusetts are all in-network and considered preferred for in-patient services on tiered HMO plans. Additionally, if you live outside of Maine part-time, often travel across the country or have a child away at college, national plans offer providers through our partnership with First Health®. And most recently, Community Health Options has been adding emergency medical services to its network, giving Members better EMS coverage, thanks to the adoption of a 2023 Maine law making that possible.

Coverage for virtual care includes telehealth options that begin with your own providers if they offer that service. If you are 18 or older—and looking for a primary care provider—you can choose a traditional in-network provider or opt for a virtual-first primary care team through Firefly Health. Firefly provides 24/7 access to a primary care team, anytime, anywhere, making it easier to access care right from your cell phone, whether you need preventive and routine care, or help managing more complex issues. Learn more about Firefly Health and download the app here.

Members also have access to urgent care telehealth sometimes. So, when you’re hurt or sick, or need care right away, of course head to the emergency room or call 911 if your condition is serious or life-threatening. However, you can save time and money using Amwell 24/7 for urgent care telehealth from the comfort of your home—at $0 cost share on non-HSA plans, and $64 on HSA plans ($0 after deductible). Amwell also offers behavioral health services like therapy and psychiatry. Scheduling is easy and you can do so online after registering, or by calling (844) 733-3627 for support. 

Perhaps most important, Community Health Options supports its network with Maine-based care teams who help Members get access to providers, including virtual care, and who have on-the-ground knowledge of local resources.

Community Health Options’ care teams are available for any question through our Member Services team. If you have questions, please call (855) 624-6463 between 8 a.m. and 6 p.m., Monday through Friday.