Health insurance can save you money on vital medical costs for your family, but you should compare plans to ensure you’re getting the benefits you need at an affordable price. Many people get their health insurance through their employers, but if you don’t have employer health insurance, you can get it through the federal government’s health insurance marketplace. Open enrollment occurs every fall, and on the marketplace’s website, you’ll find various insurance plans to choose from. Low-income families can apply for their state’s Medicaid benefits. Let’s explore how to choose the best family health insurance.
Common Health Insurance Terms
The premium is the amount you pay for health insurance. You’ll also pay a deductible, which is the out-of-pocket cost you incur for medical services before your insurance provider covers the costs. If you have a $1400 deductible, you’ll need to pay this amount before your insurance provider covers some of the costs. A copay is your portion of the payment for services that your insurance provider covers.
Now let’s discuss the different types of health insurance. A health maintenance organization is a group of providers who accept certain levels of payment for their services. When you have insurance through an HMO, you can only get services from providers within the HMO’s network. If you choose an out-of-network provider, you’ll pay more for services. HMOs also require you to have a primary care provider because you’ll need them as referrals if you need to see a specialist.
With preferred provider organizations, you’re not required to stick to providers within your network. You also have a wider variety of doctors to choose from than HMOs.PPOs don’t require you to have a primary care doctor, and you don’t need a referral to visit a specialist.
There’s also the high-deductible health plan. With this plan, you’ll pay more for the deductibles, but you’ll also qualify for a health savings account. Only patients with a high-deductible health plan can open an HSA. HSAs are accounts where you contribute money, and you can invest the funds in this account. You can only use your HSA for qualified medical expenses, and all contributions, interest earned, and withdrawals are tax-free.
Consider Your Out-of-Pocket Costs
When you choose health insurance, think about your out-of-pocket costs. These costs include your deductibles, copays, and any other expenses your insurance may not cover. If you’re someone with significant health issues and in need of frequent care, a plan with higher deductibles and lower out-of-pocket costs may work for you. But if you’re generally healthy, you may choose a plan with lower deductibles but higher out-of-pocket costs.
About Flexible Spending Accounts
Not all employers offer health insurance, but they may have flexible spending accounts. A flexible spending account is an account where you contribute money for medical expenses for you and your family. These funds are also tax-free. You can use FSA funds to pay for deductibles, copayments, medications, and the costs of certain types of medical equipment. You must use up your funds before the new year begins since you can’t roll over the benefits. For 2025, the contribution limit is $3,300.
Will Your Prescriptions Be Covered?
When choosing health insurance, think about your prescription drug coverage. Some insurance providers have lists of drugs that they cover, and your particular medicines may not be on that insurer’s list. Other insurance providers may offer generic brands and require authorization before you buy the name-brand versions of the drugs.
I’m Self-Employed. How Can I Get Health Insurance?
Your first option is to visit the federal government’s health insurance marketplace. Here you can compare different private insurance plans to determine which one is best for your budget and health needs. If you’re self-employed with a low income, you can sign up for Medicaid benefits through your state’s Department of Health and Human Services. Your income will need to be less than the amount set by your state, and you may need to provide proof of employment. If you’re married, you can get health insurance through your spouse’s employer.
Evaluate Your Current and Future Health Needs
This is another thing to consider when looking for health insurance. If you currently have diabetes and have suffered a heart attack recently, you’ll need to work with both your primary care physician and a cardiologist who will help you with recovery and developing new routines to prevent another heart attack. Maybe you’re in your 20s and good health, so you won’t need many procedures or special medications. If you’re in your 50s, you’ll need more preventative care exams, such as Colonoscopies, mammograms, blood sugar testing, and prostate cancer screenings.
I’m Unemployed and Need Health Insurance. What Can I Do?
Whether you were laid off or quit your job, there is a way to get health insurance if you’re unemployed. If you were laid off, you’re entitled to COBRA benefits, which you can receive between 18 and 36 months following your job loss. However, these benefits are pricey because you’ll pay the full premium, including your employer’s portion of the benefits, in addition to an administrative fee. Other options are Medicaid, your spouse’s health insurance, or insurance through the federal government’s marketplace.
Build an Emergency Fund
Some medications and procedures aren’t covered by insurance, and this is why you should build your emergency fund. When you have an emergency fund, you’re able to pay for unexpected medical expenses without breaking the bank, which means less stress. If you have investment income, use some of it for medical expenses.
About Dental Insurance
One reason why so many people skip dental appointments is the high costs of dental care without insurance. Let’s look at these costs:
- General cleanings: $75 to $200
- X-rays: $100 to $200
- Fillings: $200 to $400
- Root canals: Up to $1500
- Dentures: Up to $8000
It’s vital to get dental insurance to prevent dental issues such as cavities, gum disease, and tooth decay. Some employers offer dental insurance, and Medicaid offers affordable dental care for low-income families. Most dental insurance plans have four types of coverage. These are preventative care, basic care, major care, and orthodontic care. Preventive care covers exams, cleanings, and X-rays. Basic care covers fillings and extractions. Major care covers dentures, root canals, and crowns. Orthodontic care covers braces and possibly treatment for gum disease. Dental insurance generally doesn’t cover cosmetic procedures such as teeth whitening. Dental plans use the 100/80/50 structure for coverage. It’s 100% of preventive costs, 80% basic care, and 50% major care coverage.
Health insurance isn’t a one-and-done decision. Life circumstances and health needs evolve, and so do insurance plans. During your annual “open enrollment” period, take the time to review your current coverage, compare it with new offerings, and adjust as necessary to ensure your family remains optimally covered for the upcoming year, balancing both health needs and budget.