How To Pick The Right Health Care Plan

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Find the right medical plan for you and your finances.Health insurance in 2018 can feel stressful. Not only is it more expensive than it should be, but the process to obtain it isn’t exactly easy, either. Most people can either get it through the government, or through their work; most plans offer a number of different options; and sign-up periods can be confusing.

Here at DCCU, we can’t give you health care–or, well, health–but we can give you tips on how to sign up for the plan that will best fit you. As your plan choice really depends on your personal health care needs, you need to choose wisely. So, here are some potentially money-saving tips to consider when picking out a plan.

The Basics

  • Each month, whether you have insurance through your work or through the Affordable Care Act, you’ll pay what’s called a ‘premium.’
  • When you go to a doctor, you’ll have to pay out-of-pocket costs until you’ve hit your ‘deductible’ for the year; then, your insurance company begins to pitch in. Afterwards, you’ll either have co-payments with your insurance company, or they will cover 100% of the costs.
  • Most plans use in-network facilities and doctors, meaning they can limit what doctors you see and what health facilities you use.
  • If you are fortunate enough to have a job that offers health insurance, it is almost always the cheapest way to obtain it.
  • If you get insurance through the government (and, sometimes, through your employer), your monthly premium will be based on your income.
  • Preventive care is almost always free, no matter your plan.
Find a healthcare plan that is right for you.
A doctor with a patient’s x-ray film

Choices, Choices, Choices

Of course, you can’t prepare for an emergency. But you can estimate what you think your health coverage will cost for an upcoming year based on previous years. Based on health records and your current level of health, you should be able to narrow down your plan to one or two options.

The ‘Catastrophic’ or ‘Bronze’ Plans

If you’re under 30 years old and in good health, one of these plans may be your best bet. catastrophic and bronze plans generally offer very low monthly premiums and pretty steep deductibles (upwards of $5,000 per year). Essentially, if you’re young, can’t afford high premiums, and don’t plan on seeing the doctor often, these plans (as the ‘catastrophic’ name suggests) will keep you in check in case an emergency happens. If you plan on seeing the doctor a couple of times per year, these are not the plan options for you.

The ‘Silver’ Plan

The silver plan is for anyone looking for a bit more than the bare minimum. It’s usually got  medium-sized premiums and a medium-sized deductible. If you need to go to the doctor a couple times per the year, or seem to need a short-term prescription every once in awhile, this may be the choice for you.

‘Gold’ or ‘Platinum’ Plans

With a gold and/or platinum plan, you’re paying the highest monthly premium of any of the options, but your deductible is going to be very low–or, potentially non-existent–when you do seek out care. If you know you: go to the doctor often, frequently need emergency care, take regular prescriptions, are planning to have a baby or have a small child, or have surgery in the near future, this is the plan you’re going to want to have.

Are Emergency room costs covered by your medical plan?

Who Can I See?

Depending on if you get your health care coverage from the government or from your employer, your available list of doctors, pharmacies and hospital facilities may be restricted. In addition to figuring out which plan’s premium/deductible level is right for you, you’ll also probably have to consider what type of network option you want. (Sometimes, you may not have a choice.) Almost always, in-network doctors and facilities are going to be your cheapest option when you seek care.

  • With Preferred Provider Organization (PPO) coverage, you pay less for in-network providers–and you can use out-of-network providers, but it will cost you. PPOs allow you the most doctor options, so they’re especially great if you live in a rural area.
  • With Point of Service coverage (POS), you pay less for in-network than out-of-network doctors and facilities, and you’ll need permission from your doctor to see a specialist.
  • With Health Maintenance Organization coverage (HMO), out-of-pocket costs are generally low, but you can only get coverage from in-network doctors. Sometimes, emergencies are an exception.
  • With Exclusive Provider Organization (EPO) coverage, your out-of-pocket costs are, again, generally low, but you can, again, only use facilities and doctors that are within your network.

Choose the right healthcare plan

Picking the health care plan that’s right for you is a balancing act. You won’t want to have a high premium if you’re young and healthy; you’ll want to find the right fit as you age, depending on just how much care you’ve needed in the past, and how much care you estimate you may need in the future. And though it can be tricky to figure out, when you strike that balance, you’ll hopefully find yourself with affordable, proper care.

Read about Dane County Credit Union’s Health Savings Accounts for high deductible health plans.

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Tom S.

Tom is a 2006 graduate of UW Madison, currently residing in Verona with his wife and 2 girls. He has been passionate about writing ever since he was 15 years old, and displays that same enthusiasm in his work today. When he’s not sharing insightful financial wisdom, you can find Tom chilling on the Union Terrace, enjoying craft beer at the Great Dane, or hiking at Governor Nelson State Park. In the Fall he loves to take his family to Badger Football games!