Choosing a Health Insurance Plan
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Choosing a Health Insurance Plan
When it comes to buying health insurance, there are many choices. Your employer may offer health insurance or you may be able to get it through your spouse’s employer. If not, you can buy insurance through an insurance agent or through the state or federal health insurance marketplaces.
Employer-based plans may not have very much flexibility, although larger companies may offer several different plans. Individual policies purchased through an agent or in the health insurance marketplaces offer much more flexibility in terms of the types of coverage. They may be traditional major medical plans or health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Plans with richer benefits and lower deductibles have higher premiums.
Things To Know
- Insurance companies must accept customers with pre-existing conditions.
- PPOs and HMOs may restrict access to certain hospitals and doctors.
Limitations on coverage
Now that the Affordable Care Act is the law, insurance companies must provide consumers with pre-existing medical conditions with insurance. The pre-existing coverage rule does not apply to "grandfathered" individual health insurance policies. A grandfathered policy is a policy bought on or before March 23, 2010 that has not been changed to reduce benefits or increase costs to consumers. Insurance companies cannot terminate coverage unless due to fraud or failure to pay premiums or place limits on essential health benefits such as emergency services, hospitalization, prescription drugs, lab tests and outpatient services.
Insurance companies must provide coverage to consumers with pre-existing health conditions, and that coverage cannot cost more than comparable coverage for someone without that condition. In addition, insurance coverage cannot charge women more than men. Mental health coverage must be included in the essential health benefits provided by insurance companies.
Restrictions on access
Health insurance plans may restrict access to certain doctors, hospitals or labs. Certain types of insurance policies such as HMOs or PPOs, provide a list of doctors and hospitals within their network that are available for lower co-pays. You can see doctors or receive care at out of network facilities, but you will have to pay a higher co-pay than you would have to pay if you went to in-network providers.
