We turned to the experts at Stride Health to create this guide on how to choose the best health insurance plan for your personal situation.
There may be chill in the air, but November and December are not cold. In addition to everything you have to do during the holidays, it’s time to choose an insurance plan for the coming year. If you buy insurance on the individual market, you only have until December 15, which is when open enrollment closes in most states. If you get your insurance through work, you’re also probably in the middle of your open enrollment period right now.
Whatever you do, do n’t just pick a random plan to do it. We know that health insurance is as interesting as the tax laws (the two are related, more in a minute), but spending a little time researching the right plan for you could leave you healthier, with more money in your pocket, next. year.
To make the process easy, we sat down with Jordan McIntosh, a licensed insurance broker from Paso, and put together a guide to help you find the right plan for your needs. Stride can help you choose the plan that’s right for you if you don’t have employer-sponsored coverage and need help navigating individual exchanges.
Decision no. #1: HMO, PPO, EPO, or POS
There are four basic types of health insurance plans. HMO and PPO plans are the most important, and you may also have a choice between EPO and POS plans; we will explain.
HMO (Health Maintenance Organization)
- It is usually the most accessible option
- You must use network providers
- You can only see a specialist if your primary care provider refers you.
- No coverage for out-of-network providers, except in an emergency.
PPO (Preferred Provider Organization)
- It is usually more expensive
- You do not need a primary care doctor or a referral to see specialists
- Out-of-network providers are covered (but you’ll pay more if you choose them)
EPO (Exclusive Provider Organization)
- Like a hybrid HMO and PPO
- You do not need a referral to see in-network specialists, but. .
- No coverage for out-of-network care
POS (Point of Service)
- Like a hybrid of HMO and PPO, but with out-of-network coverage (unlike an EPO)
- As an HMO, you need a referral to see a specialist
- Like a PPO, you’ll pay less if you use in-network providers, but you have the option to go out of network and still receive some coverage.
How to choose: Think about how often you’ll need to see medical specialists in 2022. If you don’t anticipate needing specialists, choose the most affordable plan. If you already have certain specialists you see and want to keep seeing, choose a plan that has those doctors “in network” or one that provides some coverage for out-of-network specialists. A second thing to consider: how far you travel. HMOs and EPOs don’t offer coverage for out-of-network providers unless it’s a true emergency, so if you frequently travel for work or go to school in a different state, choose a PPO or POS, as provide out-of-network services. coverage.
Before you commit to any plan, check that plan’s online doctor lookup tool and enter your ZIP code to see how many doctors are nearby. Make sure there are a good number of doctors within a 10-20 mile radius of where you live.