Shopping the marketplace: The #1 benefit to researching health coverage

Overview: This main benefit to researching health coverage options will help you choose the ideal plan.

Choosing the right health coverage plan requires conducting personal and professional research if you want to experience the full benefits. We don’t recommend that you choose the first health coverage plan that comes your way — as rushing and picking the wrong health insurance plan could be costly in more than one way.

It’s important that you prioritize your needs — whether that involves others (families) or not. As such, the main reason you should do research on health coverage plans is because you’ll be able to compare plans across the marketplace and essentially curate what you need based on the different options in the marketplace that you’ve come across. Granted, there aren’t too many options, but there are enough variations for you to pick-and-choose certain factors.

Do research to specialize your health coverage plan to your needs

Let’s say your employer offers health coverage plans but you’d rather shop the marketplace, this is when research and time come in. Conducting your own health coverage research is beneficial even if your employer does offer plans because you get to compare the different types of health insurance plans.

You might come across one plan that offers one thing that you like and another plan that offers another thing that you like. You’ll ultimately be able to curate an “ideal” list of factors you would like to have in a health coverage plan and start to tailor your research to that.

This isn’t to say that you’ll get exactly what you want, but the more specific you could get when doing research, the easier it’ll be to sift out what you don’t want. The reality is that there might be some aspects of certain plans that you don’t need and aspects of other plans that you consider to be a must-have. Factors such as cost, in-network options, referrals, and provider choice all play a role in what health coverage plan you ultimately decide on.

main benefit to researching health coverage options

The main benefit of going through your employer for health insurance plans

If your employer offers health insurance, this already cuts the research aspect in half. While you can always search for alternative plans available in the marketplace, receiving health coverage through your employer means that you’re likely to have lower premiums since your employer pays a portion.

For the best decision, be aware of past treatment trends

Regardless of whether you choose to go through your employer or not, doing the right research should also take into consideration (1) the amount of treatment you’ve received in the past and (2) the type of treatment you’ve received in the past.

To help you narrow down choices, think about the following factors:

• You see a primary physician or a specialist frequently.

• You frequently need emergency care.

• You take expensive or brand-name medications on a regular basis.

• You are expecting a baby, plan to have a baby or have small children.

• You have a planned surgery coming up.

• You’ve been diagnosed with a chronic condition such as diabetes or cancer. Or, on the contrary:

• You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.

• You are in good health and rarely see a doctor.

Comparing common plans to start

Though it’s impossible to predict every medical expense, being aware of trends can help you make an informed decision. Let’s compare two common health coverage plans and see how they may or may not benefit you based on your needs.

HMO: HEALTH MAINTENANCE ORGANIZATION

If cost is your biggest determining factor, HMOs might be your best option. Choosing this plan means that you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Due to this restriction, HMOs tend to be the cheapest type of health plan, overall.

• You have to stay in network to get coverage except for an emergency

• Procedures and specialists typically require a referral

• There are lower out-of-pocket costs

• You get a primary doctor who coordinates your care for you

• Less freedom to choose providers

At the same time, another benefit with choosing HMO is that there is technically less work on your end, since your doctor’s staff coordinates visits and handles medical records.

PPO: PREFERRED PROVIDER ORGANIZATION

If being able to choose your specialist is your main interest when doing health coverage research, a PPO might prove ideal.

• You do not have to stay in network to get coverage

• In-network care is less expensive

• Procedures and specialists do not require a referral

• You have more provider options and no required referrals

• There are higher out-of-pocket costs

This might be better for individuals who live in a remote or rural area and have limited access to doctors and care since you may be forced to go out of the network.

Related article(s): Your Step-by-Step Guide to Choosing a Health Insurance Plan