Navigating Your Healthcare Plan

Navigating Your Healthcare Plan

Open Enrollment season is here! Your window to get health insurance is from November 1, 2015 to January 31, 2016. This means now is the time to get up to speed on insurance plans so you can make an informed choice for your care. Keep these things in mind when shopping for new health insurance.


First Things First: Which plan is right for me?

PPO (Preferred Provider Organization): A PPO plan is a contractual agreement between insurers and network providers (physicians and hospitals). This means that for the most part you’ll be limited to in-network providers, and anyone outside of that network will cost you in the form of high co-pays. One of the pros of a PPO plan is that you don’t need referrals to see a specialist for any ailment, saving a lot of time and stress. Another benefit is you don’t have to file claims on this plan and insurance is processed quickly with very little involvement from you.


HMO: If PPO is the more expensive, slightly lazier option, HMO is the opposite by generally being less expensive and more work. We’ll start with the positives. Your primary care physician does most of the legwork here, referring you to specialists. The way HMOs are managed (or highly managed) is why they’re the more inexpensive option. On the other hand, this option is a bit of a pain for people with the need for more specialized care. You’ll always be going through your primary care physician (PCP) to get to anyone else. If your needs are more general health-aligned, this option is certainly more cost-effective and straightforward. But first, make sure you like your doctor a lot…because they’ll be making a lot of decisions for you.


Fee for Service: This option ends up being the most expensive one of all and is exactly what it sounds like. An easy way to think about it is: each service billed separately. The amount that will be paid per medical service is hashed out between the insurer and the providers and the effects are not always positive. The fear here, for example, is that your doctors will now have incentive to give you unnecessary care because you coming into the office is how they get paid. On the other side of the coin, you would be welcome to come into the doctor’s office more often than not. This option is incredibly flexible, but premiums can be extremely expensive. It works great for people who’d like a bit more freedom from their health plan.


Time to Shop


Now that you’re more familiar with basic plan options, it’s time to think about whether you’re staying with your current plan or making a change.


Out with the Old or In with the New? How happy are you with your current care? Do not automatically re-enroll in your current plan without seeing what the competition has to offer. You might end up saving hundreds of dollars. When you’re shopping around, look up ratings of each plan and focus on quality. provides a great resource for information.


Consider Cost: When researching new plans, looking up reviews on quality is important, but so is knowing how much you’re paying. Premiums aren’t everything; make sure you’re paying attention to out-of-pocket expenses as well. Healthcare costs can be downright frightening when they sneak up on you. Study the Summary of Benefits and Coverage form for each plan to avoid any of these cost-related surprises later on.


Research Comprehensively: A good way to make sure you’re making the most informed decision possible is by first studying general information about choosing a healthcare plan and then narrowing it down by specific plan. You can do some of that preliminary research here and here.


Keep in mind: Online research isn’t everything: talk to an agent that can help you find the best plan for you. Visit to speak with someone today.


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