Everyone tends to want the “best” of everything they get. This is also true with regards to health insurance. Although with health insurance folks tend to want to get the best but often don’t want to pay for it. Sadly, just like with all other products you tend to pay a bit more for the best products. In many cases though depending on how one judges best, there is no additional cost for “best” health insurance. For those who look at it from lowest out of pocket cost (other than premiums) yes it will cost more for the low deductible coverage.
One reality though is that it tends to be harder to differentiate between health insurance product with the same plan design and another. It tends to boil down to the provider network, claims payments, and the customer service provided to the physicians and the members. Most folks decide on their health insurance plan based on plan design and premium charged. Of course all of my comments relate to major medical health insurance.
Premiums for all health plans are driven by the cost of the provider network as well as the expectations for care needs based on the underwriting review of the application. Thus if a carrier pays more to providers the same volume of care provided for members between plans will yield different premium levels.
Currently sicker persons may receive a premium surcharge not assessed to other members to help cover your expected increased costs. It may be depending on your medical issue that one carrier will hit you with a greater surcharge than another network will and that often can drive some of the premium costs. All of these are factors which can drive premiums on similar plans from equal quality carriers.
In the case of two plans with generally the same plan design the overall outcome of choosing one plan over the other tends to be driven by premium. Of course your key physician being in a network or not may in your eyes differentiate between the plans as one being better than the other. But, in reality, that does not really make one plan better or not than the other. Insurance policies today are a bit easier to compare than they were just months ago, but still some benefits may differ so if specific benefits are important it’s key to delve down into the details of the specific benefits critical to the end user.
Ultimately, what plan is best is really in the eyes of the buyer. But to help decide what seems best for you, it helps to look at well matched plans, ones that are of the same style (PPO or H.S.A. based) and at the same deductible per person and per family both on the in and out of network basis. Then get the accurate price for the plans you are considering. Then match the provider networks based on your needs. Once you have these things all lined up, pick the plan that looks best to you.
Unless you know specific negative issues with one carrier over another it is hard to really push one aside as being not as good as the next carrier. All of them will raise rates each year to some degree or another. Thus the lowest priced plan today may not remain the lowest priced plan tomorrow. To that end, lowest price does not equate to best plan or even best network discounts.
It’s also useful to consider that health insurance sales fall into a regulated industry. The insurers must meet state licensing requirements and their plans as well as pricing goes thru a state run approval process. Each state has their own process, and there will be some federal oversight for plans going onto the federal healthcare exchanges.
Ultimately it helps to use a professional advisor to help you pick your plan and for insurance in Texas we are here to assist with that.
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