Better Health Advisors launched four years ago to offer guidance with complex medical decisions. We expected to recommend providers and treatments, support care transitions, and help our clients manage their health. As we performed this work, it became clear that proper health coverage is key to getting great medical care. Today, we often help clients identify the best health insurance plans for their specific health and wellness needs.

The 2021 open enrollment season has arrived, and the Better Health Advisors team can guide you through your decision-making process. If you’re changing jobs, considering Medicare as an option, or comparing insurances on the health exchange, we are here to answer your questions.

Last week, we kicked off our health insurance series by answering common open enrollment FAQs. Today, we’ll focus on the costs associated with health insurance. No matter what kind of health insurance you have, you will likely have to pay out of pocket for some healthcare services. Here are four terms to know:

  1. Deductible: The amount you pay for your covered health care services before your insurance plan begins to cover the cost.
  2. Premium: How much you pay for your health insurance every month.
  3. Copayments: A fixed amount you pay for a medical service (primary care visit, specialty visit, etc).
  4. Coinsurance: The percentage of costs of a covered health care service you pay once your deductible has been met.

A basic rule of thumb is the lower your monthly premium, the higher your deductible. If you have a plan with a higher monthly premium, you can expect a lower deductible. Another question to address is whether you want to join a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). If you are enrolled in a HMO, you will have access to specific doctors and hospitals in-network. These providers and hospitals have agreed to lower their rates for those enrolled in the plan. Care is only covered if you see providers who are in-network. You can expect lower premiums and low deductibles, and it may be necessary to get referrals from your primary care provider in order to see a specialist.

If you are enrolled in a PPO, you will have the flexibility to choose a doctor and hospital. Although a network of providers exists in a PPO, patients have less restrictions when seeing non-network providers. A Primary Care Provider referral is not required before seeing a specialist. PPOs will cover care when you see providers out of network, although your costs, such as premiums, may be higher. Health exchanges are organizations in each state through which people can compare and select insurance plans. People who are not offered insurance by their employer can purchase coverage through exchanges.

For additional support in selecting a plan that is right for you, please read our article “Is Being Insured Enough?” If you have questions, email John and the BHA team at john@betterhealthadvisors.com.