It can be a financial disaster if you have a medical emergency and do not have health insurance–it can take years to recover financially. This is a risk most cannot afford to take. That is why health insurance is such an important thing to have, even if you are a young and healthy person.
By choosing not to have health insurance, you are setting yourself up to pay several fees and other costs. There are many types of health insurance, so it is important to pick a plan that is best for your unique situation. Depending on your age, health, and other factors, these are things you should consider to determine the best health plan for yourself:
Health Insurance Plans
There are several types of health insurance plans, all with different requirements and benefits. They are known by 3 letter acronyms, HMO, PPO, EPO, and POS and are the most common health insurance plans offered by insurers.
If you have a disability, there are several options you can look into for health coverage. Each has different benefits and drawbacks, so it’s important you understand each plan, and how it could possibly benefit you.
HMO plans, or health maintenance organization, is a plan that gives you access to doctors and specialist within its network. Within that network the health insurance provider has negotiated lower rates for coverage, you must visit a doctor in the network in order to receive coverage if you see an out of network provider your insurance company will not cover it.
HMO plans also frequently have other restrictions, such as the number of visits or types of prescriptions that are covered. You also must designate a primary care doctor and they must refer you to a specialist if you want coverage for visiting that specialist. HMO plans are typically cheaper than other options, but they also offer fewer benefits.
PPO health insurance plans are more flexible and generally provide more benefits than an HMO plan. They also have a network of doctors they have negotiated discounted rates with, but you are not limited to in-network providers.
This could potentially become very useful in the situation you need to see a specialist or you are traveling in another state and you happen to need coverage. You are free to see a specialist as you see fit, with no referrals from a primary doctor.
There are typically co-pays, or a small fee you must pay upfront for your visit, and also deductibles, but the coverage is generally much more comprehensive than other plans.
EPO health plans are plans that aim to combine some benefits of both PPO and HMO plans. You will get the cost-saving benefits of an HMO plan, but some of the benefits offered in a PPO plan.
Not every benefit in a PPO plan is also offered in an EPO plan, but you will have a network of doctors with discounted rates. You will also be able to go to out of network providers, but only in the event of an emergency. With an HMO, it does not matter if it is an emergency, if you go to an out of network provider, you are stuck with the bill. This can be significant if you are ever seeking care for an emergency.
POS plans, or point of sale plans, similar to an HMO plan, may require you to designate a primary doctor for referring to any specialist. You also may see out of network providers, but you will be stuck with the majority of the bill. The main difference in an EPO plan and POS plan is the benefit of full coverage at out of network providers in the event of an emergency.
What You Should Consider
What Can You Afford?
When it comes to paying for health insurance–you want to fit it into your budget so you can afford your payments each month. Your budget should include deductibles, coinsurance, copays, and unexpected medical-related fees.
For example, if you are injured on the job and look into social security disability, you may eventually need to hire a lawyer. If you don’t think it’s necessary–you might want to reconsider. Having a lawyer review your case will improve your chances of being approved.
Is it Offered Through Your Job?
Some employers may offer an employer-sponsored health plan, which most likely will be the most cost-effective option for obtaining coverage. Your employer is able to negotiate a lower rate for your health insurance because they have several people who they are seeking coverage for. The employer negotiates a discounted rate for their entire pool of employees. You are not mandated to take employer offered health insurance, but most likely it is going to be your most cost-effective option.
Would You Prefer a Private Plan?
If you decide to seek a private plan outside of your employer, or you do not have an employer offering health insurance, there are some things you should keep in mind and consider before committing to a plan.
Do You Want the Cheapest Plan?
If you are young and healthy, most likely you want to spend as little as possible on health insurance. If you do not frequent the doctor, and you not have prescriptions you take every month, you can afford to get a less expensive plan.
Do You Need the Most Expensive Plan?
If you are older, have a pre-existing condition, or take medication frequently, you would likely benefit from a higher priced plan. The higher priced plans usually offer more benefits and options than the cheaper plans.
The Bottom Line
It is in every person’s best interest to have health insurance, even if they are young and healthy. You never know when you will have an emergency or unexpected illness. Even if you choose to go with a cheaper option, some coverage is better than no coverage.
Medical debt is one of the main reasons people end up filing for bankruptcy, and by having insurance you’re likely to avoid the worst of it. If you are fortunate enough to have employer-provided coverage, that is most likely going to be your most cost-effective option. If you still need help choosing a plan, there are plenty of advisors who can walk you through your choices and what is best for you.
About The Author:
Richie started Hurricane Fitness in 2011. Starting out as a Boxer at the age of 11 and winning County, Provincial, National and International medals in Boxing, he began running fitness classes and personal training. Since then he has gone on to work alongside Olympic, World and European Champions and has trained many clients, both at home and abroad, with a wide range of goals and needs. You can find him on his website; hurricanefitnessireland.com, or on his Facebook or Instagram page.