Choosing health insurance is an important decision for everyone that requires careful consideration. As a quick summary:
- Most people receive health insurance through employer benefits.
- Those who are self-employed may have to purchase health insurance individually.
- If you retire before age 65, you will need health insurance until Medicare starts.
With such varied options depending on your individual circumstances, choosing health insurance can often be a stressful process. Here's how to choose the right plan for you and your family:
1. Select your plan type
For many people, the most important factor is the cost of health insurance. HMO (Health Maintenance Organization) plans are the least expensive, offer a lower monthly premium, and lower out-of-pocket costs for medical services. A designated primary care physician (PCP) acts as a "gatekeeper" and determines when you can meet with specialists. So the downside is that HMO plans are the most restrictive.
PPO plans impose a higher premium for greater flexibility in choosing service providers. You do not need a referral to see any specialists and you can hire doctors out of network. However, you will incur higher expenses and you may need to file a separate insurance claim. For more information on HMO and PPO plans, click here.
Point of Service (POS) plans provide the benefits of HMO and PPO plans. You choose the service, either HMO or PPO, to use every time you visit a doctor. When you see a network primary care physician (PCP), there are no deductions and preventive care is included, and he or she can refer you to a specialist. You also have the option of seeing an out-of-network provider, but at higher costs. If you want to manage your plan on a case-by-case basis and are willing to follow strict guidelines, you may find the POS plan attractive.
2. To determine the plan that best suits your financial situation, consider how the following expenses will affect your budget:
- Copayments may be required each time you visit a service provider.
- Coinsurance payments refer to the amount an insured must pay for certain services, for example, 20 percent of a hospital visit.
- Deductions require you to pay a certain amount before coverage begins.
- Policies have their own limitations and can vary greatly. Lower-cost plans have higher limits, so don't be fooled by the lower premiums. You can end up paying a large medical bill.
3. Check access to your favorite doctors
Ideally, your preferred providers are involved in your plan, especially your primary care physician. If you meet with the professionals on a regular basis, make sure that those listed in the established plan are in a suitable place.
4. Please note that plan structures may vary
Some plans may have primary, secondary, and out-of-network tiers. Using service providers within the base layer will be the most cost effective.
5. Take advantage of tax-privileged medical expense accounts, if any
There are three main types of Health Spending Account: Health Reimbursement Account (HRA), Flexible Spending Account (FSA), and Health Savings Account (HSA).
The Health Reimbursement Account (HRA) is the employer funded health spending account. Some plans may include an HRA to help cover an employee's personal expenses without taxes.
Many benefit plans offer the Flexible Spending Account (FSA) option, an option to review when selecting your annual benefits. For 2018, you can fund up to $ 2,650 in pre-tax dollars to pay for personal expenses that must be depleted by March of the following year. Over time, this leads to significant tax savings.
Finally, if you have a High Deductible Health Plan (HDHP), you can fund a Health Savings Account (HSA) up to $ 3,450 ($ 6,900 per family) in 2018. People 55 and older can contribute with Additional $ 1,000 per year. You can also transfer a one-time IRA account to your health savings account up to the contribution limits. All contributions reduce taxable income.
If you retire before age 65, you can still fund a health savings account. For example, you can fund the HSA with your pension, which will lower your taxable income. However, unlike the FSA, you don't have to drain your health savings account every year, so you'll continue to enjoy tax-deferred growth for your investments. But be sure to suspend subscriptions six months before enrolling in Medicare. Otherwise, you may incur a penalty.
Once you are on Medicare, you can use a health savings account to pay for the following expenses:
If you retire before age 65, you can still fund a health savings account. For example, you can fund the HSA with your pension, which will lower your taxable income. However, unlike the FSA, you don't have to drain your health savings account every year, so you'll continue to enjoy tax-deferred growth for your investments. But be sure to suspend subscriptions six months before enrolling in Medicare. Otherwise, you may incur a penalty.
Once you are on Medicare, you can use a health savings account to pay for the following expenses:
- Medicare (Part B) Medicare Premium (Even if it is paid for with Social Security retirement benefits, you can pay yourself.)
- Medicare benefit plan (Part C)
- Prescription Drug Plan (Part D)
- Out-of-pocket expenses while on Medicare
- Long-term care insurance premiums
Choosing your health insurance can be a daunting task. By following the guidelines above and consulting with a CFP® program specialist, you will receive the guidance you need to decide which plan is best for you.
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