Employer-provided health coverage is a huge advantage, if not a must, for job seekers in the United States. According to a study by the Society for Human Resource Management, 46% of employees with employer-sponsored plans said health insurance was the deciding factor or positive influence in choosing their current job. Additionally, 56% said whether or not they like their health coverage is a key factor in deciding to stay at their current job.
Even if you know you want to take advantage of your company’s health care offerings, you may feel a little lost when it comes to choosing the right insurance plan for you and your family. In this article, we’ll break down some of the basic things to consider to help you evaluate your options.
Reading: How to pick health insurance plans
how to choose a health insurance plan from your employers
Here are four simple steps to help you choose the best insurance option.
1. understand the types of health insurance plans
There are four main types of health insurance plans: hmo, pos, ppo, and epo. One of the main differences between plan types is whether or not they offer any type of out-of-network coverage.
In short, a network is a group of health care providers (doctors, hospitals, laboratories and more) that have a contract with an insurance company to offer services to members of that health insurance plan. these facilities and physicians must meet certain credentialing requirements and accept a discounted rate for services covered by the health plan in order to be part of the network.
in-network health care providers are those who are part of the network and accept your plan.
out-of-network providers are not contracted with your health plan and may charge you a higher full price rate for their services.
Another big differentiator is whether or not a plan requires you to have a referral from your Primary Care Physician (PCP) to see a specialist.
Related: what employee benefits to look for when looking for a job
2. familiarize yourself with health insurance terminology
You may come across some unfamiliar jargon as you review your plan.
Fortunately, healthcare.gov provides a great glossary of terms. here are some of the most important ones you’ll want to know.
This is the amount you pay for your health insurance each month. Your employer may cover some or all of your premium each month.
Keep in mind that a lower premium doesn’t necessarily mean more savings. Depending on your health care needs, paying a little more each month can translate to a better plan and more savings at the doctor’s office.
Your deductible is the amount you pay for covered health care services before your insurance plan begins to pay. For example, with a $3,000 deductible, you pay the first $3,000 of covered services.
After you pay your deductible, you generally only pay a copay or coinsurance for covered services, and your insurance company pays the rest.
maximum out-of-pocket expense
Your out-of-pocket maximum or out-of-pocket limit is the most you have to pay for covered services in a plan year. After spending this amount on copays, deductibles, and coinsurance for in-network care and services, your health plan pays 100% of the costs for covered benefits.
copayment or copay
A copay is a set fee you pay each time you see your doctor or fill a prescription. the remaining balance of your visit is covered by insurance.
Copayments can occur in two ways: immediately or after you’ve met your deductible. If your copays apply only after your deductible has been met, you’ll pay the full out-of-pocket cost for the doctor’s visit until you reach that number. if they apply immediately, you’ll only pay the flat rate each time you visit, regardless of whether you’ve already met your deductible.
Coinsurance is the percentage of the costs of a covered health care service that you pay after you have paid your deductible. You will pay this percentage until you reach your out-of-pocket maximum.
For example, a common coinsurance amount is 20%. This means that after you meet your deductible, you will pay 20% of your health care expenses and the other 80% will be covered by insurance.
3. Assess your needs and those of your family
Now that you have a better understanding of how the different plans work, start thinking about how you expect to use your plan. this is perhaps the most important part of this process, as the best plan for one person may be the worst option for another depending on individual or family needs.
Some things you want to think about for yourself, your spouse, and your dependents include:
- How often do you see your primary care doctor?
- How often do you see health care specialists?
- Do you have an upcoming surgery?
- Do you have a chronic condition, such as diabetes, heart disease, or cancer?
- what prescriptions do you take regularly?
- Do you frequently seek emergency care?
- Are laboratory tests done regularly?
- Are you expecting a baby or planning to have a baby in the near future?
- Is mental health coverage important to you?
If you’re generally in good health and only see your doctor once a year for checkups, a low-premium, high-deductible plan may be the best option for you. On the other hand, if you fill multiple prescriptions each month and see your doctor frequently, you may want to opt for a plan that pays more each month but saves you more on the health care services you use most.
4. compare offered plans
After evaluating exactly what you need from a plan, you can look at the options your employer has provided.
comparison of benefits
Each plan must have a summary of benefits that explains what is covered and what is not. review the benefit summaries for each of your options, noting which ones you check the boxes for your health care needs.
If you want to continue seeing your current doctors and health care providers, you’ll want to see whether or not they’re in a plan’s network. You can see if a doctor is in-network by visiting the company’s website or by calling your doctor’s office directly.
Compare the out-of-pocket costs for each plan below. compare your monthly premium to your expected savings based on coverage and your average health care needs.
take your time and ask questions
While you’ll likely want to make your selection before the end of the enrollment period, take your time to choose the plan that’s best for you. If you have any questions, don’t hesitate to ask a member of your employer’s human resources or staff team. You can also contact your insurance provider or your enrollment team representative if you have questions about a specific plan and what it covers.
At jobsage, we set out to build an employer review site around the things that matter most to job seekers: inclusion, growth, purpose, feedback, flexibility, and compensation. we want to help you find the right employer by getting answers to the questions that matter to you, including what a company’s benefits package looks like.
Join jobsage to get guidance on your job search or to leave a review for your current employer to create a more open and transparent conversation in and around the workplace.