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How to Determine the Health Insurance Plan for Your Family

Posted by Johnson Memorial Health on Dec 8, 2015 10:00:00 AM

Choosing a health insurance plan can be complicated. There are many variables that go into each plan, and the details can be hard to understand. Income, age, and financial situation may also play a large part in the plans available to you and your family.

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Certain employers have to offer basic health coverage to their full time employees, but they are not required to offer benefits to the employees family. An employee is not required to take the insurance offered by the employer. It might be a good idea to see the other options available to you and your family.

Deciphering Jargon

When you start researching plans, you will run across some insurance jargon.

  • Monthly Premiums-the amount you pay the insurance company each month, whether you use the coverage or not.
  • CoPay- The amount you pay for each doctor visit or prescription, usually a set dollar amount
  • Out-Of-Pocket Costs- This is usually described as a maximum annual dollar amount. It is the amount you will pay out of pocket in addition to the monthly premiums.
  • Deductible- The amount you pay before insurance starts covering some of the cost. High deductible plans usually cost less than low deductible plans.
  • Coinsurance- the percentage you pay after the insurance pays for a portion of the services
  • Provider Network- Plans offer lower prices for using doctors or hospitals within their network. Out of network services will cost you more.
  • Types of Plans- HSA, HMO, PPO, EPO all stand for different types of plans. Click here for more info.

Decision Tips

  • Spend time researching the best options, but make a decisions quickly. There are consequences for not having healthcare insurance.
  • Discover which insurance providers your preferred doctor accepts. If there aren't any doctors in your area that accept your healthcare plan, it is probably not the right plan for you.
  • Employer provided healthcare, the marketplace, or private insurance companies offer benefits. Take a look at each, and compare the cost/benefits.
  • Low income healthcare may be an option for you and your family. The new HIP 2.0 provides coverage to low income Hoosiers between the ages of 19 and 64.
  • Think about your monthly budget when you are looking at premiums. While a low monthly premium may look good at first, the fine print details about out of pocket maximums may prove they are not the best deal.
  • Think about what type of plan you want to have.
    • HMO- low cost plans with a monthly premium and copays, must stay in network except for emergencies
    • PPO- monthly premiums, deductibles, coinsurance, and more provider options, in-network discounts
    • EPO- monthly premiums, copays, must stay in network
  • Compare covered benefits. Some plans offer better emergency care, while others offer better mental health services. Some plans may cover less for certain medications or conditions, like maternity care. Think about your family's needs.

Learn more about the new HIP 2.0.

Topics: Insurance, HIP