Updated: Aug 18, 2022
Open enrollment for health insurance is fast approaching and choosing/changing a health plan can be overwhelming. What plan meets not only your needs but your family’s needs? Rehab and Revive wants to help in your decision making. There are some questions you should ask yourself before picking new insurance. As a bonus, we are going to give you some tips on how to select the plan that will best cover your costs at an out-of-network clinic, like ours.
What kind of plan is it?
There are two general types of insurance plans that you can enroll in: Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). HMO premiums are typically lower, and deductibles are usually small or nonexistent. The downside is that only providers that are in that HMO’s network are covered. Any services with a non-preferred provider will not be covered and will be entirely the patient’s responsibility. PPO’s are generally more flexible when choosing a provider and have fewer restrictions on services and number of visits. These types of plans, however, are traditionally more expensive and have deductibles.
Does it fit in my budget?
Only you can truly answer this question. Although a PPO may have more perks, if the plan doesn’t fit in your budget, it may be time to look into some HMO’s. The best way to see if you can make an HMO work for you is by paying close attention to what providers and hospitals are in your network. If you’re satisfied with the coverage, then an HMO may be for you. If your nearby hospital isn’t covered and there are too many restrictions on care that you know you will need, it may be worth it to invest in a more expensive PPO.
Is it FSA/HSA eligible?
Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) are great perks that be the icing on the cake of your insurance plan. They allow you take money out of your paycheck (pre-tax, so it’s a bit of a tax break as well) and put it toward medical expenses. Sometimes, your employer will match what you set aside. You can then use the money on this card for you and your dependents for copays, prescriptions, etc.
What is my coinsurance and/or copay and deductible?
As mentioned earlier, a couple of very important things to watch out for are deductibles (the amount of money you pay before your insurance starts covering the costs), copays (the amount you pay when you see your primary care or pick up a prescription), and co-insurance (typically a percentage of how much your insurance will cover for a particular health service). For example, a 100% coinsurance may sound great on the surface (your insurance will cover 100% of your costs after hitting your deductible), but if you have a $20,000 deductible, that might not be the most practical. It’s important to balance the cost of the premium, with the deductible and copays/coinsurance so that you are paying as little out-of-pocket as possible.
Can I keep my current doctors?
This is a huge factor for many people. If you have spent years shopping around for your favorite Primary Care Physician or you have a pre-existing condition that you see a specialist for, it might be a deal breaker for you to be able to keep these doctors. Make sure, if you’re thinking about picking a new plan, that you check to see if your favorite providers would still be covered. If you’re not over the moon with your PCP or you don’t go to the doctor enough to care, then you can skip this step.
Does this plan adequately cover my prescriptions?
Checking prescription coverage on insurance plans is crucial, especially if you have a pre-existing condition that requires you to take medication regularly. No one wants to break the bank because their prescriptions are poorly covered. Often, prescriptions are divided into tiers for coverage. Take a look at what types of prescriptions are most important to you and what kind of coverage they have.
BONUS: How can I pick a plan to help cover my out-of-network costs?
What is my out-of-network deductible?
PPOs generally have an in-network deductible (like what was mentioned above) and an out-of-network deductible. Sometimes, plans will combine the two, but it’s relatively uncommon. If you want to come to a place like Rehab and Revive that is either out of your insurance’s network or out-of-network completely, you may want to look into a plan that has a lower out-of-network deductible. Therefore, you’ll have to spend less on services at an out-of-network office before your insurance begins covering.
What is the coinsurance?
Just like for an in-network provider, you’ll want to take a look at what the coinsurance percentage will be once you hit your out-of-network deductible. You’ll want to find the right balance between a lower deductible and a high percentage of reimbursement.
Do I have an FSA/HSA card?
Rehab and Revive does accept FSA and HSA cards! Many of our patients utilize this great resource here as well as at other out-of-network offices! For more information about what these cards are, see question 3. If you happen to forget your card, most HSA and FSA accounts allow you to pay up front with your own credit card and then seek reimbursement after filling out a few forms.
Well, there you have it. In summary, it’s all about balancing the premium with the potential costs. Of course, many, many more things can play a role into picking the plan that’s best for you and your family, but if you’re having a hard time finding a place to start, we’ve got you covered. Also, if you love Rehab and Revive Physical Therapy or another out-of-network provider, we hope that you can use the bonus tips to getting more of those costs covered!
Let us know how we can help you. Always remember, we can, and we will get better, together!