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7 Tips on Choosing a Better Health Care Plan for You and Your Family

on 3 Nov, 2018

Getting health care?

How do you know which policy works best for you? How do you know you’re getting your money’s worth?

The health-care cost inflation in Canada is trending downwards in 2019. While this is still quite high, it’s still a better choice than paying for your medical expenses in full.

With that said, it can be hard to choose which one is the right health care plan for you. There are a lot of factors to consider, with the cost as the most important consideration. There are also different types that can cater to different needs.

How will you then choose which one is a better health care plan? Read on to find out how you can find the right one for you.

1. Compare the Types of Health Care Plans

The type of plan for you will depend on your budget and health care needs. There are 4 basic categories: HMO, PPO, POS, and EPO.

Health Maintenance Organizations

An HMO is an association that sells a package of medical services for a fixed price. It issues a primary care physician for each patient, who then determines if you need a specialist. If so, he/she will refer you to one within the same network.

If you already have a doctor, you should check if he/she is in the network of the HMO. It will not cover your visits if your PCP doesn’t issue a referral.

Preferred Provider Organizations

PPOs have more coverage as they allow you to go outside of their network. However, you’ll receive fewer benefits if you do so. As such, it might be hard to predict your out-of-pocket costs.

Point-of-Service Plans

This is more versatile than PPOs and HMOs. It still designates a PCP for each patient, but you can choose to go outside of their network.

Exclusive Provider Organizations

An EPO plan also has a network but without a primary care doctor. It might also cover visits out of their network, but it usually won’t.

2. Consider Your Pre-Existing Conditions and the Waiting Period

All the medical lingo can end up too confusing that people might forget checking if the plan covers their pre-existing condition. Plans also usually have a waiting period, wherein you can’t make a claim during a certain period of time after getting the plan.

During the waiting period, some or all your plan benefits will not take into effect. The initial period usually lasts 30 to 90 days, which would prevent the people with a recent diagnosis from making a claim. However, if you have a pre-existing condition, the coverage for the services you’d need might not begin until after 12 to 48 months.

3. Study the Covered Services

While we’re talking about coverages, make sure to be thorough in reviewing which services and medical conditions the plan covers. Knowing what the coverage includes will prevent any surprises when the bill comes.

For example, going to the emergency room with a condition that the plan doesn’t consider as an emergency will force you to pay the whole sum out of your own pocket. Some plans are pretty selective on the services they cover, too. They might cover a certain service during an urgent care visit but not cover it if you do it outside the ER.

Women who are expecting to be pregnant in the future should also check which OB-GYN services they can charge to the insurer. Some plans also now include fertility treatments, too.

If you like getting regular examinations, check if the health care plan covers this as well. Most plans include annual screenings, but some independent providers might not cover this.

You might also like to consider a plan that covers prescription drugs, especially if you’re taking some. Ask for the insurer’s drug list and bring it to your doctors. They might be able to prescribe the medications on the list instead.

4. Look at the Added Benefits

You’re getting a health insurance plan, so why not ensure that you’re getting the best benefits as well? Choose one that can help protect you and your family whatever happens. Consider adding in additional features like coverage for vision and dental care.

Some plans are also offering extra services, such as mental health care, drug and alcohol rehabilitation, counseling, nursing home care, and more. Some even include perks like a free gym membership or a discount on hearing aids.

5. Calculate Your Out-of-Pocket Expenses

You’ll need to shoulder a part of your medical expenses, so first, look at how much the annual deductible is. This is the total amount you’ll have to pay out of your own pocket before the insurer takes over the remaining balance. Make sure that you can shoulder this when choosing a health care plan.

Then you also have copayments and coinsurance terms to consider. Some plans might charge a copay, which is a fixed amount for doctor visits or prescription drugs. This will usually not count toward your deductible.

Coinsurance, on the other hand, involves both the insurer and the insured in paying the bill. The usual percentage is 80/20, where you pay for 20% of the bill after paying your deductible.

6. Figure Out Your Worst-Case Scenario

Your worst-case scenario is the maximum amount you’ll pay should the worst happen to you. This would include your annual premiums and your out-of-pocket expenses.

If you have poor health, you might want to choose the plan with the least out-of-pocket expenses. Otherwise, you can consider the plan with the lowest premium instead.

Still, keep in mind that the best plan for you might not be the most attractive one in terms of costs. If you want to save, check out the next tip.

7. Prevent Additional Costs

Look for more ways to save on medical plans, such as incentives and discount health plans. Some plans might be offering incentives for participating in healthy activities. This might include visiting the gym, walking, lowering the cholesterol, and such.

This would help you bring your bills lower, but you can further save by checking every bill that comes in. See if there are any mistakes you can dispute. Medical bills add up in an instant; make sure you’re not paying more than you need to.

Choose a Better Health Care Plan for You

The tips above should help you find the right plan for you.

If you want a better health care plan, though, talk to medical insurance brokers. They will help you assess your needs and choose the most suitable plan. Talk to us now and let’s get you started!

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