But how do you make the right choice? The first thing to do is to ensure that your doctor accepts your new insurance plan. This is crucial, and here’s why: By directing plan participants to a limited group of hospitals and doctors, insurers can negotiate discounted rates on how To Make Money In It Consulting’s care, the same way Costco can buy in bulk and offer members discounts. These health care providers make up your insurer’s so-called network. If you go a doctor who doesn’t have an agreement with your insurer, you may have to pay out-of-network rates for your care, which are typically twice as expensive in-network rates, according to benefits consulting firm Mercer. Plus, if you go outside your network, some Affordable Care Act protections do not apply.
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For example, under the ACA, you pay nothing for preventive care like annual physicals, vaccinations, and some counseling services—but only if you receive the care from an in-network health care provider. Read Next: How Good Is Your Employer’s Health Plan? 13,700 for families, and plans often set lower limits. Insurer websites typically let you check whether your primary doctor is in-network before you enroll in a plan.
But if you’re considering several insurers, that can take time, and the insurers’ directories aren’t always up-to-date. So if you have only one or two doctors, just call the offices and ask whether they are in-network. As long as you have other options, eliminate any plans that your doctors don’t accept. Before you choose the best insurance plan, you need an idea of what your typical health care costs are. You should be able to find a list of your medical claims on your current insurer’s website.
But here’s a quicker way to benchmark your spending. What was your deductible last year? A deductible is the amount of money you must spend out of pocket before insurance covers a portion of the bill. Once you’ve hit your deductible, all you will owe is a co-pay or co-insurance.
Your insurer picks up the rest for in-network care. 37 for specialty care, according to KFF. Here’s the upside: You will usually pay lower monthly premiums if you agree to a higher deductible. A good rule of thumb is that if you didn’t come anywhere close to hitting your deductible last year, you can probably choose an even higher deductible this year and save on premiums, says financial planner Rick Kahler. Just make sure you have the savings to pay the full deductible if you or a member of your family needs care. But if you surpassed your deductible or came close, paying more for a plan with a lower deductible might save you money overall if that means owing just co-pays or co-insurance earlier in the year. In that case, check each plan’s cost-sharing rules.
Do this simple equation to compare plans: Multiply each plan’s monthly premium by 12, then add the out-of-pocket maximum, says Katy Votava, founder of health insurance consulting firm Goodcare. That’s how much you could pay in total if you suffered a medical crisis this year. Consider the average PPO plan vs. PPOs—the most common plan offered by employers—let you see doctors in- and out-of-network but charge the highest premiums. When you do the math, though, you’ll find that the plans with the lowest premiums carry a hidden risk—more of your money is on the line if you ever get sick.