How to Choose the Best HMO Plan
Important Questions for Consideration
Whether you’re already insured or you’re in the market for healthcare coverage, you may be struggling to understand the terms of your plan or the ones you’re considering. Choosing—and using—HMO insurance can be perplexing. You may ask:
Which procedures, conditions, and medical tests are covered?
What are the financial details?
What are the options regarding choice of doctors?
Sources of Health Insurance Information
According to recent report, Less than 50% of Nigerians had medical insurance. Majority of those insured got their medical insurance from an employer while few subscribed to either private family plan, private individual plan or a community plan, While more than 50% are yet to be get insured. Some people feel that HMO policy is a scam, others says its only a poor man that get HMO insurance seeking for whom to bear their risk while some also feels that they want to get all they need without hindrance i.e the waiting time for approval request in some case. Perhaps they are yet to be sensitized about the HMO operations.
No matter how you obtain your coverage, there are resources to help you select the best plan for you and your family, complete the enrollment process, and use your health insurance when you need it.
If you work for a small company that doesn’t have a human resources team, you have several sources of information to turn to:
- The health insurance carrier
- The broker who helped your employer choose the coverage (ask your manager to direct you)
- Your employer’s third-party payroll/benefits company, if there is one
- You may also contact Oshobaba’s Blog for possible assistance.
If you’re shopping for insurance on your own (because you’re self-employed, for example), Oshobaba’s Blog is available to help you online, over the phone, or in-person at no charge. We can help you compare plans both on-exchange and off-exchange.
Weighing Your Options
In some cases, health insurance plan options are limited (if an employer offers only one option, for example). But most people have a few choices.
Your employer may offer a range of plans with varying coverage levels and monthly premiums. If you buy your own health insurance, you can select from any plan available in the individual market in your area.
If you’re eligible to enroll in HMO, you’ll have the option of picking Advantage plan that will suite your needs.
There’s no one-size-fits-all when it comes to health insurance. The plan that will be best for you depends on a variety of factors:
Do You Have a Pre-Existing Condition?
Thanks to the Affordable Medical Care System in Nigeria, no health insurance provider can turn someone away because they have a chronic disease or other medical problem when they apply for coverage (a practice called medical underwriting).
However, if you have a pre-existing condition, you’ll want to consider what you need from your health insurance in order to manage it, since benefits, out-of-pocket expenses, covered prescription medications, and provider networks vary considerably from one plan to another.
One Plan or Two?
If one member of your family has a pre-existing condition or is anticipating significant medical expenses in the coming year, consider enrolling the family in separate plans, with more robust coverage for the person who’ll need more healthcare during the year.
Do You Take Any Prescription Drugs?
Be sure to check the medication lists of the health plans you’re considering. You may find that one plan covers your drugs in a lower-cost than another—or that some plans don’t cover your medication at all.
If you’re enrolling in or already covered by HMO, you can research which plan will suite your needs. It will help you determine which plan will work best for you.
Do You Want Care From a Particular Provider?
Provider networks vary from one carrier to another, so compare the provider lists for the various plans you’re considering. If your provider isn’t in-network, you still may be able to use that provider but with a higher out-of-pocket cost, or you may not have any coverage outside the network.
Do You Anticipate Expensive Medical Care Soon?
If you know you or a covered family member is going to have surgery, for example, or you’re planning to have a baby, it may make sense to get an insurance or if you are already covered by a health plan but if of lower plan, you may increase your premiums.
How Comfortable Are You With Risk?
Do you prefer to spend more on premiums every month in exchange for out-of-pocket expenses? Do you have money in savings that could be used to pay for your healthcare costs if you opt for a plan with a higher deductible?
These are questions that don’t have a right or wrong answer, but understanding how you feel about them is a key part of picking the health plan that will provide you with the best value. The monthly premiums will have to be paid regardless of whether you use a million dollars’ worth of health care or none at all.
But beyond the premiums, the amount you’ll pay throughout the year depends on the type of coverage you have and how much medical care you need. All non-grandfathered plans cover some types of preventive care with no cost-sharing— But beyond that, coverage for other types of care can vary substantially from one plan to another. If you select the plan with the lowest premiums, be aware that your health coverage are likely to be lower if and when you need medical care.
A Word From OshoBaba
Health insurance is essential, but it also can be frustrating and complicated. Regardless of whether you have a government-run plan, coverage offered by your employer, or a policy that you bought for yourself, a solid understanding of how health insurance works will serve you well.
The more you know, the easier it will be for you to compare plan options and know that you’re getting the best value from your health insurance coverage. We are always available if you have questions.
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