A legacy-driven media platform documenting Korean excellence in culture, economy, and identity
Jennifer E. Cho, MD, FACOG
As the new year begins, one of the important things to consider is your health insurance plan. It is essential to carefully review your health status and choose the insurance plan that best fits your needs. Here are some basic pieces of information you should know before selecting a health insurance plan.
1. What is the most important first step in choosing a health insurance plan?
Most health insurance plans offer a minimum set of benefits. For example, regular check-ups for adults and children, maternity care, diagnostic services, prescription drugs, outpatient care, emergency services, and hospitalization. For most people, health insurance is tied to their employer, which means their options may already be limited. If you do not receive health insurance through your employer, you can compare plans through the Health Insurance Marketplace. Premiums vary based on your income. There are also options available for low-income individuals, families with children, pregnant women, and seniors. To receive benefits for 2021, you must enroll between November 1 and December 15 of the previous year, but there may be a special enrollment period this year if you qualify. For more details, please visit healthcare.gov. You can also purchase health insurance from individual insurance companies, but in this case, there may not be many options for selecting the best plan.
2. What types of plans are available to me, and which one should I choose?
To get a general overview of the various types of plans, please refer to the chart. The best plan for you depends on your and your family's healthcare needs. If you only need a plan from a specific insurance company and do not require many options, an HMO plan can be a cost-effective choice and is generally cheaper. However, if you want a wider range of options from different insurance companies, PPO and EPO plans may be more suitable.
3. What are HSAs and FSAs?
- HSA stands for Health Savings Account, which is available only to individuals with high-deductible health plans. Eligibility is granted only to those who are not Medicare-eligible and have only a high-deductible health plan.
- FSA stands for Flexible Spending Account, which is provided as part of an employer's benefits package. The money in this account can be used for out-of-pocket expenses, costs not covered by insurance, and co-insurance bills. Both HSAs and FSAs allow you to set aside money for medical expenses and are pre-tax deductions from your wages. In most cases, a debit card is issued for medical expenses.
4. Comparing insurance benefits and out-of-network hospital costs
The details of health insurance plans vary based on my and my family's needs. The importance of insurance benefits packages and out-of-network hospital costs can vary significantly depending on what I need, and thus the actual plan may end up costing more. It is essential to honestly assess what type of health insurance I and my family require. Are you expecting a new baby next year? Do you have children? Do you frequently suffer from headaches? What kind of medications do you need? Where do your medical expenses arise?
If you are generally healthy, do not incur high out-of-network costs, and only visit a doctor for routine check-ups, it makes sense to choose a plan with lower monthly premiums and higher out-of-pocket costs.
If you have chronic conditions that require more medical services, are taking expensive name-brand medications, are planning surgery, are expecting a baby, or generally anticipate higher medical expenses, you should opt for a plan that covers more medical costs. In this case, a plan with higher monthly premiums would be better.
5. Are there other terms I should know?
Premium refers to the amount you must pay regularly each month for your insurance plan.
Copays are the amounts you pay out-of-pocket when receiving care, whether at a hospital, emergency room, or for prescription medications.
Deductibles are the specific amounts that a patient must pay before insurance begins to cover medical costs. This typically applies only during a specified period within a 12-month timeframe.
Coinsurance plans generally require the patient to pay a certain percentage of medical costs after the deductible has been met. Most coinsurance plans split costs at 80/20 or 75/25, where the insured pays 20-25% of the total costs, and the insurance company covers the remainder.
For more detailed information, please refer to the following links:
www.healthcare.gov
https://www.consumerreports.org/health-insurance/guide-to-health-insurance/
https://www.nerdwallet.com/blog/health-insurance/
