Comparison of Health Care Insurance

When seeking health insurance, you want to pick the plan that best meets your needs. Comparing several different health plans from multiple insurance companies will help you decide which plan is best for you and your family. Reviewing monthly premium costs, the potential out-of-pocket costs of care, which doctors participate in the health plan and what conditions and services are covered will shape your decision.

Premiums

• The premium is the cost of the actual health insurance policy. When insurance is employer-sponsored, the employer may share the premium cost with the employee. Employers pay the premium while employees pay back the employer through payroll deductions. Many employers offer several insurance options with different costs per plan. Consumers with individual plans must pay the entire premium each month, or pre-pay, depending on the health plan type. Premiums may run from very high to low, depending on the plan type, group size (for employer-sponsored plans), age and health of the consumer (for individual plans).

Out-of-pocket Costs

• In addition to the premium, out-of-pocket costs, such as deductibles, co-insurance and co-pays, may factor into your comparison of health care insurance. The deductible is the dollar amount that must be paid by the individual before the health plan begins paying for services. This amount can range from zero to thousands of dollars. Co-insurance is the shared cost between the health care plan and the insured. For example, a plan that pays for 80 percent of services means that the insured has a 20 percent co-insurance. She is responsible for 20 percent of the doctor's bill. Co-pays, a responsibility of the individual, are payable at the time of service.

Provider Network

• When comparing health insurance plans, you want to confirm that your doctor participates in the plan's provider network. This is not an issue for indemnity insurance plans where there are no networks and you see the doctor of your choice and submit claims for reimbursement. However, if you are looking at Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) coverage, networks are important. HMOs require participants to use their network of physicians and hospitals while PPOs allow out-of-network coverage but give deep discounts to participants using network providers. You can check the insurance company's online provider search tool to see if your providers participate in the network.

Benefit Exclusions

• Health insurance plans may choose to exclude certain benefits and services from coverage. These may include anything, from cosmetic surgery, pregnancy and infertility to gastric bypass surgery. These exclusions vary from plan to plan, and certain conditions or services may be covered through purchase of a separate benefits rider. If you have a specific condition, disease or service you need covered, compare the benefit exclusions of each plan before making an insurance selection.