If you’re looking to purchase a health insurance plan, then there are a few tips you should keep in mind. By following these tips, you’ll find the perfect health insurance plan to fit your budget.
Tiered network plans have lower copays and deductibles
A tiered network is a health insurance benefit design that divides a provider’s network into tiers, one for higher quality and higher cost and one for lower quality and cheaper. Depending on the plan, you may have to pay higher copays or deductibles for visits to high-priced providers in the top tier, but you may save more than you would in a traditional plan.
For example, Blue Cross Blue Shield of Massachusetts (BCBSMA) offers tiered-network plans, which sort hospitals, physicians, and other providers into three tiers. The benefits are a reduced out-of-pocket spending and more choice.
The company analyzed medical claims data from its members to determine which tiered networks were the best for reducing total medical spending. It found that enrolling in a tiered-network plan reduced spending by more than four percent.
Exclusive provider organization (EPO) is a hybrid of an HMO and a PPO
If you’re looking for a managed healthcare plan, you may want to consider an exclusive provider organization (EPO). These compare health insurance plans have features of both PPOs and HMOs. You’ll still need a primary care physician, but you can choose to receive your care only from providers in your network.
EPOs can be a good choice if you don’t mind a limited number of providers and don’t mind having to pay out-of-pocket costs. They aren’t as restrictive as PPOs. However, you should make sure you’re getting all the services you need.
If you’re a health insurance consumer, you have probably heard the terms “deductible,” “copay,” and “coinsurance.” They refer to the amounts you have to pay each month or year before your health coverage kicks in. Each one is important.
Short-term health insurance plans are cheaper than private or individual health insurance
Short-term health insurance plans are available for periods of less than a year. They offer fewer medical benefits than ACA-compliant plans, but are generally cheaper.
Short-term health insurance is intended for people with temporary gaps in their coverage. It is a way to get health care during times of illness or transition between employer-sponsored health plans. However, it’s not ideal for anyone looking for long-term coverage. If you have a chronic condition or high health risk, you may not qualify.
Short-term health plans are also not required to cover the 10 essential health benefits. That means you may not receive benefits for maternity care, prescription drugs, mental health services, and substance abuse treatment.
There are other limitations to short-term health insurance. Some providers do not operate in your state, which could affect coverage.
Exclusions and limitations of health insurance plans
Exclusions and limitations are provisions within health insurance plans that specify what services and equipment are not covered. These limitations may not be as obvious as other features of a plan, so it’s important to read the fine print before purchasing a new policy.
Pre-existing conditions, also known as pre-existing diseases, are conditions that were diagnosed and treated before the start of a plan. The exclusions and limitations on these plans vary, depending on the company and the state in which you live. Some health insurance policies even include a waiting period, so that you cannot make a claim for any medical expenses until the end of the period.
Other exclusions include cosmetic surgeries, which are not typically covered by a standard health plan. Likewise, drug and substance abuse treatment is generally excluded. However, some plans do offer coverage for reconstructive dental care.