Choosing the right healthcare plan depends on whether the doctors and hospitals you want to use are in-network. These networks include doctors, clinics, surgery centers, labs, pharmacies and medical equipment companies that have agreed to provide discounted services to health insurance plans.
Different types of healthcare plans have different provider networks. For example, a health maintenance organization typically limits members to only seeing providers within the network, while a preferred provider organization (PPO) usually has more extensive networks and allows members to see specialists without referrals.
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Make sure you check your health insurance company’s provider directory and online tools before scheduling appointments to verify that the doctors or facilities you want are in-network. This will help you save money and avoid costly surprises later.
Look at Your Out-of-Pocket Maximums
During open enrollment, it’s important to look at your annual out-of-pocket maximum. This is the highest amount you will pay for healthcare services in a year before your insurance starts to cover the cost of care. It’s a combination of your deductible, copays and coinsurance. Your premium payments don’t count toward your out-of-pocket maximum, and costs above your insurance’s “allowed amount” won’t apply either.
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High deductible health plans (HDHPs) typically have lower monthly premiums, but may take longer to meet your deductible and out-of-pocket maximum. Talk to your human resources or benefits representative about how these differences might affect you when selecting a plan. Also, consider supplemental insurance plans that can help with unexpected medical bills.
Look at Your Benefits
Whether you’re shopping for a health plan on your own, or are looking at options offered by your workplace or the health insurance marketplace, you have the right to receive an easy-to-read summary of costs and coverage called a Summary of Benefits and Coverage (SBC). This will help you make "apples-to-apples" comparisons between plans.
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