Health insurance is a crucial decision that requires careful consideration. Just like any major purchase, it’s important to compare the cost and value of the coverage you’ll receive. When shopping for a health plan, the monthly premium is the initial price you see. This is the amount you pay to your insurance company to maintain your coverage. However, it’s essential to look beyond just the premium and consider what it will cost you when you actually use your benefits and whether you’ll have access to quality care.
Managing Director and veteran benefits consultant of Hilb Group’s Houston office, Fernando Martinez says “Employers focus on factors like budget, getting the best value for money (resources), offering diverse options, and encouraging engagement with the health plan. On the other hand, employees prioritize self-observing their health needs, considering the expense of the plan, ensuring ease of access to care, and seeking out resources that support their healthcare decisions.”
In addition to the monthly premium, there are several other factors to keep in mind when choosing a health plan. These include checking if your preferred doctors and hospitals are in the network, understanding what services and prescription drugs are covered, knowing how much the insurance company will pay for covered services, determining your out-of-pocket costs for things like doctor visits, prescriptions, and hospital stays, and being aware of any deductibles and which services they apply to.
Mr. Martinez suggests that “balancing these priorities is essential for both parties to ensure that the health insurance plan is effective and sustainable. It’s equally important to understand that each company is different with regards to industry, demographic and geographic, one size does not fit all.”
To find the best health plan that suits your budget, it’s important to familiarize yourself with common cost-related terms such as cost-sharing, copayments, coinsurance, and deductibles. Cost-sharing refers to the amount you pay out-of-pocket for healthcare services, while copayments are set amounts you pay for covered services. Coinsurance is the percentage you pay for certain services, and the deductible is the amount you pay before the insurance company starts covering costs. Reviewing the Summary of Benefits for each plan can help you understand the cost-sharing for different services.
It’s commonly believed that a higher premium usually means paying less out-of-pocket. However, it’s important to consider your anticipated healthcare needs for the year when choosing a plan. If you expect to use services frequently, a higher premium plan may be more cost-effective. On the other hand, if you don’t anticipate using healthcare services often, a lower premium plan may be more affordable. There are also programs that Waive Out Of Pockets entirely by creating competition inside the health plan to take away the monopoly from the major carriers, like Blue Cross, United, Cigna and Aetna (BUCAs).
Mr. Martinez is known in the benefits consultant industry for finding better alternatives to the status quo “My last point would be not to fall into the ‘since they do it, we should be doing it’, mindset. There are so many options to choose from that allow for out-the-box strategies to be successful when evaluating against the more common main stream carriers (BUCA’s) if you will.”
To reach Fernando Martinez for further advice, contact him at fmartinez@hilbgroup.com
