3 things to know before you pick a health insurance plan

3 things to know before you pick a health insurance plan

Choosing the right health insurance plan is one of the most important decisions you’ll make. Health insurance comes with a variety of options that affect cost, coverage and choice of health care providers. Read the following health plan tips from Noble AMA IPA before you enroll in a health insurance plan. If you are familiar with your health plan, use our physician directory to locate a physician in your area.

1. Metal Categories

Accepted Noble AMA IPA health plans fall under four “metal” categories: Bronze, Silver, Gold and Platinum. Each category is based on the cost of premiums, deductibles, copayments and choice of providers for health care services.

  • Bronze: You’ll pay the lowest premiums and the highest deductibles and copayments for Bronze plans. If you rarely use medical services and do not regularly take prescription medications, a Bronze plan may be right for you.
  • Silver: Your premiums will be slightly higher than a Bronze plan, but your deductibles and copayments will be lower. Choose a Silver plan to receive extra savings if your income qualifies you for cost-sharing reductions. Silver is also a good choice if you don’t mind paying a little more each month for routine health care coverage.
  • Gold: You’ll pay high monthly premiums, but your deductibles and copayments will be low. If you regularly receive a lot of medical care and need more coverage, a Gold plan may be your best choice.
  • Platinum: These plans have the highest monthly premiums and the lowest deductibles. Platinum is a good choice if you need a lot of care and are willing to pay high premiums in return for nearly complete coverage.

2. Health Insurance Plans and Network Types

Before you choose from the health plans accepted by Noble AMA IPA, it’s important to understand the different types of health insurance plans and network types. The type of plan will determine which health care providers you can use and whether your care will be covered.

  • Exclusive Provider Organization (EPO): This managed care plan only covers services from hospitals and providers in the plan’s network (except in emergencies).
  • Health Maintenance Organization (HMO): This health insurance plan only covers doctors who work for the HMO, except in emergencies. Wellness and prevention are priorities.
  • Point of Service (POS): Your copayments are lower if you get care from in-network hospitals and providers. To see a specialist, you must have a referral from your primary care provider.
  • Preferred Provider Organization (PPO): You pay less for care from in-network hospitals and providers. You can see an out-of-network provider without a referral for a higher copayment.

3. Your Total Costs for Health Care

Deductible, copayments, coinsurance, out-of-pocket maximum — just what do these terms mean for your health care costs? Before you choose a health insurance plan, make sure you understand how much you’ll have to pay.

  • Deductible: How much you pay out of pocket before your insurance plan pays. You never have to pay for preventive services.
  • Copayments and Coinsurance: After you reach your deductible, you’ll pay this amount for each health care service.
  • Out-of-Pocket Maximum: After you pay this amount out of pocket, your insurance company will pay 100% of the total cost of covered services.

Consider how much each family member uses health care services. When searching for plans at Healthcare.gov, you can choose whether your family members’ health care use is low, medium or high. The website provides tools for estimating your premiums and out-of-pocket payments — your total health care costs. Based on your total costs, you can choose a Bronze, Silver, Gold or Platinum plan.

Navigating health care plans can be overwhelming. At Noble AMA IPA, we can help you find the best health insurance for you and your family. Contact us today with any health insurance questions you may have.

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