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How to Choose a 2019 Health Plan

Close-up view of health insurance benefit application forms

It’s that time again: Open Enrollment for health insurance. If you’re in the market to renew, change, or enroll in a new health plan, now is the time to brush up on your health insurance knowledge.

When Does the 2019 Open Enrollment Period Begin?

Open Enrollment for a 2019 health plan starts on Nov. 1 and ends Dec. 15.  

Which Health Plans are Available for 2019?

A variety of health plans may be available to you, whether you enroll through your employer or the Health Insurance Marketplace. It’s good to understand each type before you make a decision. 

Here are four common health plan types:

  • HMO (Health Maintenance Organization): This type of plan requires you to choose a primary care doctor to refer you to specialists within a network of providers. Out-of-network care may not be covered, except in an emergency.
  • PPO (Preferred Provider Organization): This plan offers the highest level of coverage when you choose doctors and hospitals within a network. Out-of-network doctors and hospitals will cost you more. 
  • EPO (Exclusive Provider Organization): This type of plan lets you choose doctors and hospitals within a network. Out-of-network doctors and hospitals are not covered, except in an emergency. 
  • POS (Point of Service): This plan offers higher coverage for in-network doctors and hospitals. You will need to choose a primary care doctor to refer you to specialists. 

You may also qualify for government-sponsored health insurance programs:

Which Health Plan Will Work Best for Me?

That depends on how much coverage you need. For instance, if you rely on prescription drugs or services for a chronic condition, you’ll want to pick a plan that covers these things. If you’re younger than 30, relatively healthy and don’t anticipate using many health care services, you may want to look into a catastrophic plan

How Much Will Health Insurance Cost?

When shopping for a health insurance plan, take note of the premium. This is the monthly cost to stay enrolled in the plan. You may also be subject to the following out-of-pocket costs:

  • Deductible: The amount of out-of-pocket cost you must pay before your health insurance company starts covering health care services. It’s important to be aware of the deductible amount when shopping for a health plan. 
  • Co-pay: A set fee that you will pay every time you get a specific health care service. For example, you may have a $20 co-pay when you visit your primary care doctor or a $40 co-pay when you see a specialist. 
  • Coinsurance: Your share of the total cost of a health care service. Your health insurance company will pay the remainder.

If you receive health coverage through an employer, you may be able to set aside untaxed money to pay for certain health care services:

How Can I Keep My Health Care Costs Down?

  1. Know your network. Many plans offer higher coverage for in-network doctors and hospitals. It’s important to know which providers and services are covered before you make an appointment. Not sure who’s covered? Contact your health insurance company.
  2. Get referrals when needed. Certain plans require referrals for specialists. You will need to request a referral from your primary care provider before you receive care. 
  3. Choose generic medications: They are just as effective and usually available at a significantly reduced cost compared to their name-brand equivalents. 

Why is Health Coverage Important?

Health insurance protects us in multiple ways: It helps keep costs down in case of a serious illness or emergency. Additionally, most plans cover preventive care — such as check-ups, screenings and immunizations — at low or no cost. Preventive care is one of the most important ways we can keep ourselves healthy.

Which Health Insurance Plans Does Penn Medicine Accept?

Penn Medicine accepts a variety of insurance plans. See a list here.

About this Blog

Get information on a variety of health conditions, disease prevention, and our services and programs. It's advice from our physicians delivered to you on your time. 

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