Choosing your health insurance is a task that warrants your attention every year. Even if you’re happy with your coverage, it’s still a good idea to review your options to ensure you’re making the best choice for your health and wallet. Here are the three most common types of health insurance plans along with what to consider for each.
HEALTH MAINTENANCE ORGANIZATION (HMO)
With an HMO plan, you are given a list of doctors within a network (who either work directly for the HMO or contract with it) and pick a primary care physician to oversee all your care.
Pros: HMOs are often the most affordable choice because they typically have lower monthly premiums, which is the amount you pay each month for your coverage. Because an HMO often focuses on wellness and preventive care, it can help you maintain a healthier lifestyle.
Cons: Your choices are limited to the network’s list of providers, and your insurer typically won’t pay for a provider who’s outside the network (or it will make you pay a much higher proportion of the cost). Plus, if you need to see a specialist, you’ll most likely need a referral from your primary care physician.
PREFERRED PROVIDER ORGANIZATION (PPO)
For PPO plans, you have a list of pre-approved providers who contract with the plan, rather than providers who work directly for it. While reimbursement percentages vary for seeing someone out of network, a 60/40 split is common, which means the insurer pays 60 percent of the costs and you cover the remaining 40 percent.
Pros: In addition to having a greater choice of doctors, you won’t need to ask for a referral to visit a specialist.
Cons: A PPO will likely cost you more than an HMO, as they typically have higher monthly premiums and copayments. In addition, you often have to pay a deductible (the amount you pay out of pocket before your insurance benefits kick in). So if you have a $1,000 deductible, this means you will pay the entire $1,000 for any medical services you receive before insurance kicks in.
HIGH-DEDUCTIBLE HEALTH PLAN (HDHP) WITH A HEALTH SAVINGS ACCOUNT (HSA)
As the name suggests, HDHPs have high deductibles (and usually lower monthly premiums). For 2021, the IRS defines an HDHP as one with a deductible of at least $1,400 for an individual or $2,800 for a family, but they can be higher. Maximum annual out-of-pocket expenses (including deductibles and copayments, but not premiums) for HDHPs can run up to $7,000 for an individual or $14,000 for a family.
To offset the high deductible, insurance companies that offer HDHPs will often allow you to set up a health savings account (HSA). The money you put into an HSA is contributed pre-tax, and if you use it to pay for qualified medical expenses, there’s also no tax on withdrawals. (Note that if you use that money for something other than medical costs, you’ll pay taxes plus a penalty.) For 2021, the IRS will allow you to set aside up to $3,600 annually for individuals and $7,200 for families in your HSA. If you don’t use all the money within the year, the funds roll over for future use.
Pros: If you typically don’t require many medical services, paying lower monthly premiums and setting aside tax-free money in an HSA could save you money. Many routine screenings, such as colonoscopies and mammograms, are also covered free of charge.
Cons: If you do go to the doctor often, the out-of-pocket expenses can add up quickly. Remember, you could be paying up to $7,000 for yourself or $14,000 for your family each year, which you’ll need to account for in your budget.