Securing health insurance can help you significantly reduce the costs of medications, doctor’s visits, emergency care, and other healthcare services. But with a variety of plans available and many different types of policyholders, it can be challenging to know which coverage option is best for you. If you’re shopping for health insurance for yourself, your family, or your business, here are a few basics to help you make an informed decision.

Understanding Health Insurance

Premiums

Your premium is the amount you pay—usually on a monthly basis—to be enrolled in your insurance plan.

Deductibles

A deductible is the set amount of money you will have to pay out-of-pocket for certain health services before your insurance coverage kicks in. 

Copayments

Copayments are agreed amounts you pay on routine health services—such as physicals and prescriptions. This co-pay remains the same each time, whether or not you’ve met your deductible.

Coinsurance

If you have coinsurance, you must pay a certain percentage of covered services. In some cases, this payment may go toward the deductible.

Levels of Coverage

When you enroll in a plan through an insurance company or the health insurance marketplace, you can choose from four basic levels of coverage: bronze, silver, gold, and platinum.

Bronze is the lowest level of coverage for the most affordable premium. However, with this plan, you’ll have a high deductible and be responsible for 40% of costs.

By contrast, platinum is the most expensive option. It will pay 90% of your medical costs and keep deductibles low.

Silver and gold fall in between this range, offering mid-range coverage for moderate pricing.

Types of Plans

Health Maintenance Organization (HMO)

HMO plans only cover services from healthcare providers that are within the insurance company’s network, except in emergencies. Typically, you’ll need a referral from a primary care doctor to see a specialist.

Preferred Provider Organization (PPO)

With a PPO plan, you can see healthcare providers that are both in and out of the coverage network. Those that are out-of-coverage will cost more. Referrals are not necessary.

Exclusive Provider Organization (EPO)

EPOs work similarly to HMOs in that they only cover in-network providers, except in an emergency. However, EPOs typically offer a wider selection of covered providers and do not require referrals.  

Point of Service (POS)

With a POS plan, you can see both in-network and out-of-network providers. However, the latter will cost more. You’ll also need to get referrals from a primary care physician.

 

Navigating affordable health insurance options isn’t something you have to do alone. When you’re a client of Northwest Insurance Company in Crandon, WI, an experienced agent will guide you through a variety of high-quality plans that match your coverage needs and budget. These experienced professionals will also provide clear answers on how your selected plan works. To learn more about their auto, business, life, and home insurance products, visit this agency online. For quotes, call (715) 478-2215.