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Your Step-by-Step Guide to Choosing the Right Health Insurance Plan

It's no secret that nuances of health insurance can be difficult to navigate, especially in the United States. As an employer offering health insurance, there are complex laws and regulations that need to be followed to remain in compliance. 

Likewise, if you're in the process of shopping for a health insurance plan, there are a lot of important considerations to keep in mind. If you're feeling a little overwhelmed by the process as an employer or employee, you're certainly not alone.

By following a few simple steps, however, you can make a better informed and more confident decision regarding your health care plan.


1. Check Your Network

health insurance plan networkEmployees should begin by considering your current network of doctors and health care professionals. For example, do you have a specialist that you have to see on a regular basis for an existing medical condition? If so, and if you don't want to have to change doctors along with your health plan, then you'll want to find a health insurance policy that includes your specialist as an in-network provider. 

Employers would be well served to consult with employees (especially in smaller organizations) or conduct surveys to find out their in-network provider preferences. From there, employers should focus on offering insurance plan options that include these doctors and specialists as in-network providers. 


2. Compare Different Types of Plans

As an employer, you'll need to decide on the specific type of health care plan to offer—or you may choose to offer more than one option for workers to choose from, which is more common in larger organizations.

If your employer offers more than one of these types of plans, which will be best suited to your needs? If you're self-employed or your employer doesn't offer health insurance, you can find all these plan options and more on the marketplace.

For employers looking to offer a health insurance plan, it is important to know your responsibilities.

Some of the more common types of plans include:


  • HMO (Health Maintenance Organization) - a plan that typically requires referrals for specialist visits and offers a network of providers to its policyholders.
  • PPO (Preferred Provider Organization) - a plan that does not require referrals for specialist visits and provides both in- and out-of-network coverage.
  • EPO (Exclusive Provider Organization) - a plan that doesn't require referrals to see specialists but does require you to see in-network providers (except for in emergencies).
  • HSA (Health Savings Account) - a high-deductible plan where most of your expenses are paid out of a dedicated health savings account until your annual deductible is reached.




 3. Compare Out-of-Pocket Expenses

health insurance plan moneyEmployees and employers alike should be wary of selecting health insurance plans based on low monthly payments alone. There's a good chance that these types of plans will come with higher out-of-pocket expenses, meaning workers end up spending more money up-front before your coverage will really kick in.

When assessing out-of-pocket expenses, be sure to look specifically at annual deductibles (both for individuals and families), out-of-pocket maximums, and co-pays.

A deductible refers to the amount the policyholder will pay in a given year before your insurance will begin making payments. Even then, depending on the  specific coverage, policyholders will likely still be responsible for a percentage of the remaining expenses until the annual out-of-pocket maximum is reached. This amount is the absolute maximum that will be paid for covered services out of one's own pocket.

Co-pays, on the other hand, refer to the amount policyholders are required to pay up-front for certain covered services. For example, most health insurance plans will have a co-pay for emergency room visits, so workers may find themselves automatically paying $50 for a single emergency room visit.

With all these potential out-of-pocket costs in mind, it sometimes makes more sense for employers (and employees) to spend a little more on their monthly insurance premiums in exchange for lower deductibles and co-pays.


4. Consider Your Specific Needs

health insurance planEmployees should take some time to consider their current medical needs, as well as the needs of any family members (spouses, dependents, etc.) who will be on the plan. If you or a family member has a pre-existing medical condition that requires special care or a costly prescription medication, then you'll want to make sure you find a plan that includes the best coverage for that specialized care or treatment. 

Employers, by the same token, should consult with employees to find out more about their specific coverage needs when putting together a workplace health insurance plan. After all, offering the right plan to offer your employees can make a huge difference in your employee retention and morale.


5. Consult With an Insurance Broker

Even upon following these steps, it is possible that employers might feel the need for additional help in choosing the right insurance plan for your needs and budget. If this is the case, consider meeting with an insurance broker who will be able to speak with you to get a better understanding of your unique needs and make a personalized recommendation.

You can learn about the 4 traits to look for in a health insurance broker in our recent article.

The benefits of working with a broker far outweigh the drawbacks of selecting the wrong health insurance coverage for your company, and any commission to your broker is paid out by the insurance carrier you end up choosing, so there are no out-of-pocket costs to you!

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Craig Prince Craig’s background is quite diverse. His current focus is on Group Health Insurance, Medicare, Life, Disability, and Retirement Income, Keyman insurance, and Business Buy-out policy. Craig enjoys one-on-one with his clients to find the specific need of each employee or individual involved in the process.

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