Health Insurance for First-Time Buyers
Buying health insurance for the first time can be daunting. Choosing a plan can be overwhelming whether you’ve aged out of a parent’s/guardian’s health coverage, are experiencing a significant life change, or are not covered by an employer insurance plan.
This post will cover a few topics every first-time buyer should know.
How does individual insurance work?
Individual insurance is a health policy one can purchase for themselves or their family. When purchasing insurance, you pay premiums to the insurance company. In exchange for paying your premium, the insurance company will help cover specific risks, such as most doctor and hospital visits, wellness care, prescription drugs, and medical devices.
What should you do before purchasing a health plan?
- Assess your insurance needs.
- Are my preferred providers (Doctors, hospitals, etc.) in-network?
- Are my medications covered, and is my pharmacy in-network?
- Do I want a Health Savings Account (HSA) compatible plan or a traditional plan?
- Do I need medical coverage only, or do I also need routine dental and vision coverage?
- How long do I need coverage for? Short-term (less than a year) or long-term?
- Compare policies with different carriers.
- Individual and family plan options are entirely different from employer options. If you had an employer option with an insurance company, you cannot assume coverages and provider networks will be the same through the individual marketplace.
- Choose a plan that is in your budget.
The different individual health plans available and their benefits:
HMO (Health Maintenance Organization): HMOs typically have lower premiums and benefit cost-share, such as co-pays, but these plans rely on their network of doctors, hospitals, and other healthcare providers who agree to accept payments for certain services. If you visit a provider that doesn’t participate in the network, you may be responsible for paying the entire cost—except emergency services. Emergency services are covered both in and out of the network through an HMO plan.
Most HMO plans require you to list a Primary Care Physician (PCP) on file with the insurance company. You may also need a referral from your PCP for specific tests or to see a specialist.
PPO (Preferred Provider Organization): PPO plans typically charge higher premiums and benefit cost-share. PPO networks provide more provider flexibility than an HMO plan. PPO plans to provide both in and out-of-network benefits. Out-of-network provider cost share will be higher than in-network. You are not required to have a PCP and do not need referrals for any services with a PPO plan.
If you travel a lot, a PPO plan may suit you better. Some PPO plans include a regional network of providers to choose from.
You can search the Affordable Care Act (ACA) Health Insurance Marketplace plan options through healthcare.gov or contact your local insurance broker. We recommend speaking with a broker. They can answer any questions or concerns, help compare and narrow down plan options, and help with any issues or claims. In addition, they are here for you throughout the year, not just when you enroll!
At Group Plans Inc, we provide comprehensive reviews of plans to ensure you purchase a plan that fits your needs and budget accordingly!
Contact us today to schedule an appointment with one of our trusted advisors! (623) 889-7600 / Info@GroupPlansInc.com
