If you are getting your health insurance through a private insurance company, there are five types of common health insurance plans that you can choose from:
High-deductible health plans (HDHPs):
This is a type of private health insurance plan where you will have a higher deductible but lower premiums. With a higher deductible, you are responsible for more health care costs before your insurance coverage kicks in. Because high deductibles can result in costly medical bills, these types of plans make more sense for people who do not seek health care services often. When these plans are paired with a Health Savings Account (HSA), they are referred to as “Consumer-Directed Health Plans.”
If you have a choice to enroll into an HDHP, think twice before joining, especially if you have a chronic illness. If you are on specialty medications, have a complex treatment plan, or see specialty doctors often, it will be very difficult to pay upfront all of the out-of-pocket costs at one time. Upfronting the costs will be likely expected of you if you have an HDHP because of the high deductible.
If your employer ONLY offers an HDHP, you may not have a choice but to enroll into one. After you are enrolled, we suggest that you consider the following:
1. Reach out to your HR or benefits team to walk through your benefits. Whether you meet them in person or by email or phone, it’s important to contact them to understand your plan benefits and what your options are.
2. When speaking with them, explain that you have a long-term health issue that will require additional management and negotiations with the insurance company. Be clear that this needs to be addressed as soon as possible to ensure that you have a continuity of care.
3. You do not need a physical health insurance card to make a call to the health insurance company. Once confirmed that you are enrolled into a plan, proactively call your health insurance to figure out your benefits.
4. Since it can take 7-21 days to receive your health insurance card, you can ask your Human Resources department to get you’re a temporary card if you need one to receive the medications you need.
5. THE MOST IMPORTANT: Make sure you ask your HR representative about whether or not your HDHP has a copay accumulator adjuster. This is the newest way that insurance companies are trying to cut costs and affecting chronic disease patients negatively.
This is a type of private health insurance plan where you can access both in-network and out-of-network care without needing a referral. However, you will pay a higher amount when you use an out-of-network provider and these out-of-network costs can sometimes be considerable.
Point-of-service plan (POS):
This is a type of private health insurance plan where you may need a referral from your primary care provider to see a specialist and will also have some coverage for out-of-network care, but with higher-cost sharing. These out-of-network costs can sometimes be considerable.
Health Maintenance Organizations (HMOs):
This is a type of private health insurance plan where you choose or are assigned to a primary care provider who acts as your “gatekeeper” and refers you to specialty providers and inpatient care within the HMO network. There is no out-of-network coverage.
Exclusive provider organizations (EPOs):
This is a type of private health insurance plan where you can only access in-network care. You usually do not need a primary care provider or a referral to see a specialist. There is no out-of-network coverage.