Eight Factors in Choosing the Right Health Plans and Benefits

At OnPulse, we want to provide information that helps people make informed decisions at every point during the healthcare cycle, and this post will examine the front end: choosing plans and benefits.

Specifically, we have put together a list of eight considerations when making choices, and some of them could be potentially surprising. The first three come from a familiar source—healthcare.gov—and even though they are basic, they make for great review items. The final five come from the OnPulse team.

  1. We have all heard of the “four metals” of health care plans (gold, silver, bronze, and platinum) and we probably realize that they represent different levels of plans and costs. But there is a myth that needs to be reiterated and then debunked: the more precious the metal, the better the plan and care. This is simply not true. The way the costs are put together and shared per plan do not directly affect care and outcomes.

  2. Think about all of the costs of care, not just the premium. It is vital to remember that the premium must be paid each month even if the associated benefits are not used. And the other costs are important too, such as deductibles and prescription costs. The idea here is that you probably should tabulate all of the potential expenditures and then pick a plan, not the other way around.

  3. Do you know the meanings and differences between all of the following: HMO, PPO, POS, and EPO? First, the answers: Health Maintenance Organization, Preferred Provider Organization, Point of Service, and Exclusive Provider Organization. It would take its own blog post to go through all of the implications of the different types of organizations, but know this: each type of network comes with its freedoms, choices, and costs. If the most important factor in choosing a plan is retaining your current primary care physician, then you should take the time to get into the appropriate type of organization.

  4. Basic demographic information is still preeminent in terms of choices and cost: health status, age, gender, job, income, job-related benefits choices.

  5. Most people are terrified of high-deductible plans—and they should not necessarily be. Based on your basic demographic data (see #4) and your usage in a given time period (whether it is a year or two or five) you might be able to see significant savings in choosing a high deductible plan, and paying what seems like “a lot” at times of usage. The converse is also true: most people are thrilled to have a fancy plan—and they should not necessarily be.

  6. This goes hand in hand with #5, but always think about money spent over time. Of course this is different in specific circumstances, but in the vast majority of cases, people will save money with lower premiums.

  7. Did you know you can buy your own plan at any time? Because people don't know this, or forget, or are frightened, they tend to remain status quo.  Shopping around based on your specific needs as well as accumulating information on various plans can often save money.

  8. While it may be surprising to staff at a provider’s office when your son or daughter arrives with an individual insurance card, the truth remains: everyone in the family does not need to be on the same plan. Again, review the available choices from your employer for starters, but then think outside the box for each person in the household. You might be surprised at what you discover.

If you need further explanation of any of these items, or have further questions, please contact us at hello@onpulse.com or chat anytime.