Five tips for choosing the best health insurance plan
Navigating benefits enrollment can be challenging when you don’t know where to start. It’s hard to feel empowered to make the smartest decision for your family when you feel overwhelmed by all the choices.
We asked ARJ’s Reimbursement Services team for their top five tips for understanding the health insurance marketplace and individual benefit plans.
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High Deductible vs. Low Deductible
Many employers offer more than one insurance plan―and it’s important to compare each plan closely to know where you can save money. When choosing between a high-deductible or low-deductible plan, there are external costs that may make a substantial difference in your total health-plan cost. Evaluate your healthcare needs and ask yourself:
What are my average monthly prescription costs?
How often do I see a specialist vs. a primary care physician?
Saving $15 a month may actually cost you significantly more in the long run. Talk with a trusted source if you have questions about how to proceed.
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Prescription Plans
Prescription plans vary and it’s worth taking a look at the benefits each plan offers. There are different tiers that include high-quality and low-quality drug plans that could affect your bottom line dramatically. Look at the monthly costs for refills vs. unplanned refills on each plan. Out-of-pocket expenses and co-pays can add up. Make sure you’re not paying more than you need to pay.
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HSA and HRA
Many employers offer a health savings account (HSA) or health reimbursement arrangement (HRA) plan. An HSA is a tax-advantaged medical-savings account, and the funds contributed are not subject to federal income tax at the time of deposit. An HRA is a tax-advantaged employer health benefit plan that reimburses employees for out-of-pocket medical expenses and individual health insurance benefits. These plans can generate significant savings in overall health benefits.
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Co-Pays vs. Out-of-Pocket Expenses
It’s also important to know the difference between co-pays and out-of-pocket expenses. A co-pay is a fixed amount you pay for a covered healthcare service. Co-pays can vary for different services within the same plan―prescriptions, lab tests, and visits to specialists, for example―and can also be covered through some insurance plans. Out-of-pocket expenses are expenses for medical care that aren’t reimbursed by insurance, including deductibles, co-insurance, and costs for all services that aren’t covered by your healthcare plan.
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What’s the Bottom Line?
If you have an employer plan, ask your benefits department to give you specific totals of how much is covered by the group plan vs. out-of-pocket expenses. It may not be easy to spot the differences, but they can have a significant impact on the overall healthcare plan. Knowing what’s covered can help you make the best decision about which plan to choose.
Learn More
Our team of reimbursement experts are here to guide you through the marketplace exchange plans, commercial insurance, Medicare and Medicare replacement, state Medicaid plans, and supplement coverage.
If you are a current ARJ patient or family member, contact our Reimbursement Department at 866-451-8804 and ask to speak to a Reimbursement Specialist »
