As the clocks fall back, the afternoons grow darker by the hour, and the weather turns wet & chilly, the desire to hibernate rather than exercise becomes more appealing. Comfort foods, such as chili, lasagna, and casseroles, become, well, comforting.

Gyms are closed and school sports are non-existent, but we try to take advantage of a sunny day by taking a stroll through the neighborhood. Even though “winter is coming”, we try to maintain a somewhat active lifestyle and healthy diet.

This is also the time where you can apply for health insurance through open enrollment. Most people receive their insurance through their employer or are on their spouse’s coverage. If your job doesn’t provide health insurance, you will need to shop on your state’s public marketplace or federal marketplace. If you are unsure where to begin, visit healthcare.gov, enter your zip code, and you will be directed to your available exchange.

As of now, you are still able to purchase health insurance through a private exchange or through the insurer directly but keep in mind that you may not be eligible for any tax credits on your monthly premiums.

When looking at heath insurance plans, you’ll find a slew of options that look like a string of letters that may not make much sense. There is the HMO plan: Health Maintenance Organization; EPO: Exclusive Provider Organization; POS: Point-of-Service Plan; and PPO: Preferred Provider Organization.

To better understand the differences, here is a chart that outlines what each plan generally offers:

*Source: https://www.xcelhr.com/resources/best-hr-articles/hmo-vs-ppo

Your specific situation and family medical needs will drive your choice when selecting a plan. HMO and POS plans typically requires you to see a primary care physician before visiting a specialist. But because of these restrictions, HMO plans tend to have lower premiums.

HMO and POS plans also may require less work when finding a specialist as your doctor’s staff will coordinate those efforts on your behalf. As you reference the above chart, if you choose a POS plan and need to go out of network, make sure you get a referral from your doctor ahead of time to reduce your out-of-pocket costs.

On the other hand, if you would like to choose your own specialist, then a PPO or EPO plan might be better suited for you. The big difference here is that EPO plans are generally more accommodating to those living in metro areas whereas a PPO plan is better for those living in more remote areas with limited access to healthcare. This is because out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan.

Whatever you plan you choose; the key is to stay in-network as your costs will be significantly lower. This is because insurance providers will negotiate favorable rates with in-network doctors.

What about all those other fancy terms that are associated with health insurance plans? When reviewing health insurance, you might come across phrases such as deductible, coinsurance, copay, out-of-pocket max, etc. Here is a brief explanation of each:

  • A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. This is usually a fixed amount and standard for most health insurance plans.
  • A deductible is the set amount you pay for medical services and prescriptions before your coinsurance kicks in. Lower deductibles tend to be more expense than high deductible plans.
  • Coinsurance is the percentage of costs you pay after you’ve met your deductible.
  • Out-of-pocket maximum is the most you could pay for covered medical expenses in a year.

Finally, what are some additional questions you should be asking before you select a plan? Here’s a short list to make sure you find the best plan for you and your family:

  1. What benefits are included? Some plans may include dental, vision care, or other special services. Also look at what prescription drugs are covered.
  2. Are routine exams covered? Mammograms, pap tests, immunizations may or may not be covered depending on your plan.
  3. Are my current doctors covered?
  4. If I’m sick, will the plan make it easy to find care? The plan may cover urgent care clinics or virtual care options.
  5. Does the plan have coverage options for alternative therapies? If you’re curious about acupuncture, or planning to have a baby at home, some plans may help to cover some of the costs associated with alternative medicine.

Thank you –

The Team at White Raven Financial