Choosing Individual Health Insurance | Rocky Mountain Health Plans Blog

By RMHP

IndividualFamIns

Questions to Ask When Selecting Your Health Insurance Plan

Open enrollment for 2020 health coverage in Colorado is November 1, 2019, through January 15, 2020. If you don’t already have health insurance through another source, like an employer, parent, spouse, or partner, you may want to purchase an individual health insurance plan.

With the number of individual plans available, though, a question we often hear at Rocky Mountain Health Plans (RMHP) is, “Which health insurance plan should I choose?”

The plan that’s right for you may not be the right fit for someone else — there’s no such thing as one-size-fits-all insurance. It’s important to ask the questions that are specific to your situation when choosing a new individual health plan.

1. Explore individual marketplaces

Many people purchase individual health coverage through a government insurance marketplace, or exchange. By purchasing a plan through a marketplace, those who qualify can receive income-based discounts on monthly premiums in the form of a subsidy.

States like Colorado have their own exchanges. Colorado’s exchange is called Connect for Health Colorado. Residents of states without an exchange can use the federal marketplace. To find your insurance marketplace, visit HealthCare.gov and enter your zip code.

You can also purchase a plan directly from an insurer, like RMHP, or work with a health insurance broker.

2. Compare types of health insurance plans

As you research plans, you may see several different acronyms — including HMO and PPO:

  • Health maintenance organization (HMO) plans require you to use in-network providers. Some plans require you to choose a primary care provider. If you need to see a specialist, a referral is usually also required. HMO plans generally have lower monthly premiums and lower annual deductibles.
  • Preferred provider organization (PPO) plans also have a list of in-network providers, but many offer an out-of-network benefit. Additionally, many PPO plans allow members to see any provider within the network with no referral required (even for specialists). PPO plans have more flexibility in terms of providers, but they do tend to have higher monthly premiums.

3. Review the plan’s network

One of the biggest differences from one plan to another is the network of health care providers members can visit. Be sure to consider these criteria when reviewing networks:

  • Are your current doctors in the network? If you’re willing to find new doctors, you may not be as concerned with a new plan’s network. However, if you want to keep your current providers, be sure to review the plan’s providers carefully.
  • Which hospitals, specialists, pharmacies, and emergency rooms are considered in-network?
  • How many in-network doctors are local? This is especially important if you live in a small community where options may be limited.
  • What happens if I get sick while traveling domestically or internationally?

4. Check the plan’s drug formulary

A formulary is the list of drugs and prescription medications covered by the plan. If you regularly take medications, it’s important to check the formulary to make sure your drug is listed.

5. Compare out-of-pocket costs and benefits across health insurance plans

Each plan has a summary of benefits that outlines covered services and how costs will be shared between you and the insurance provider. Services and costs differ between plans, so be sure to select a plan with benefits and costs that best work for your lifestyle. It may be helpful to know some insurance terminology when reviewing these documents, so take a look at this helpful glossary of health insurance terms during your research.

Get help choosing a plan

If you’re a resident of Colorado in Mesa or Delta counties and are interested in learning more about your options that may work best for your Colorado lifestyle, RMHP can help. Call our local Individual & Family Sales team at 800-453-2981, option 4, or email individualsales@rmhp.org. We’re available Monday through Friday from 8:00 a.m. to 5:00 p.m.

Share: