It may seem challenging to choose a health insurance plan. These five factors should be
considered when selecting health insurance for you and your family.
For more details on the various parts of your plan for primary care, consult the Summary of
Benefits and Coverage (available from an insurance company), get in touch with the insurer
directly, or visit the insurer’s website.
So, before searching for a “direct primary care physician near me,” learn the factors to consider
when selecting health coverage.
Type of Plan and Provider Network
Does the insurance plan network include the hospitals, physicians, and pharmacies you prefer?
It’s important to remember that insurance policies only pay for in-network treatments and
medications; out-of-network therapies and medications may incur greater out-of-pocket costs or
may not be reimbursed.
It’s crucial to remember that an insurance plan’s out-of-pocket maximum might not apply to out-
of-network costs.
Make sure your preferred traditional primary care doctor is part of the plan’s network and the
neighborhood drugstore. If you are a member with direct primary care, you don’t really need to worry about in-network or out-of-network issues.
Premiums – How much will your insurance cost per month?
Whether or not you use medical and pharmaceutical services, premiums are what you pay for
your insurance coverage. You must pay the majority of the premiums every month to avoid
losing your coverage.
Remember that there are other expenses related to coverage in addition to these. You will also
be responsible for paying deductibles and cost-sharing for most healthcare services and
treatments, including copays and coinsurance.
Reimbursable – What expenses must be met before your insurance begins to pay?
If your deductible is $1,000, your health insurance won’t start to pay for most expenses until you
have paid $1,000 in out-of-pocket expenses.
Specialist consultations, treatment costs, and sometimes even prescription drugs may be
considered out-of-pocket expenses.
Many preventive services, such as permitted cancer screenings and vaccines, are frequently
covered with no cost-sharing before you reach your deductible.
Patients who select a high deductible plan will likely have to pay a lesser monthly premium than
those who select a low deductible plan. Insurance providers frequently require a deductible
payment before supplying most medical or pharmaceutical services.
Ask your insurer if your plan has a single, combined deductible for medical and pharmacy
services or a separate deductible for prescriptions to learn how much you’ll have to pay before
your prescription meds are covered.
Co-pay or Co-insurance
Do you know if there are any additional costs associated with receiving care?
Remember that you can still owe money for extra out-of-pocket expenses even after paying
your deductible.
These could include:
● The portion of a prescription or service’s price you are liable for is known as co-
insurance.
● Co-pays are set sums you must pay for covered services or prescription medicines
(often listed on the back of your insurance card)
Medical Insurance
Will your insurance plan cover your regular prescriptions?
A formulary, or list of drugs covered by the plan, is provided by each insurer. Patients may not
have insurance coverage for a drug if it is not on the formulary, and obtaining coverage may
take a long time.
Additionally, tiers are utilized to set prospective costs and co-insurance percentages and to
categorize the list of medications that are covered.
To ensure that your current drugs are covered and that you are aware of potential out-of-pocket
costs, make a list, and compare it to the plan’s formulary.
Conclusion
When selecting a health coverage plan, it is essential to consider all options carefully. There
are factors to consider, such as the cost and coverage of the plan, the deductibles, copays and
coinsurance, and any additional services offered.
Additionally, it is important to consider the provider network, the quality, and reputation of the
plan, and if the plan meets your family’s needs. Ultimately, it is important to research and
compare different plans to ensure that the plan you select is the best option for you and your
family.
Meridian Springs Primary Care is a direct primary care & concierge care clinic serving Houston
& surrounding areas. We have board-certified family physicians, affordable care & telemedicine
access 24/7. Contact us to learn more!