Premiums, copays, and health networks oh my! Are you drowning in the land of health insurance plans? The average Canadian isn’t taught how to differentiate plan A from plan B.
In fact, there are entire careers that focus on finding and explaining health insurance differences (health insurance brokers).
The best health insurance plans may not be jumping out at you, from your long list of options. That means you need to do your homework and sort through the details.
Or if you don’t want to do that, you can hire an insurance broker, but more on that later.
Ready to learn about plan comparisons? Read below.
When it comes to health insurance plans the big things are the same. You pay each month for a certain amount of coverage and you have a pool of insurance money to access if you need it.
But when you look at the differences from plan to plan, things get more confusing. It seems like one plan is the same as the other except for subtle details.
In this article, we’ll teach you how to compare the best health insurance plans against each other with a few different strategies.
But first, we need to go through a quick health insurance vocabulary lesson. If you can’t read the jargon in the insurance plan you don’t know what you’re paying for.
And we always recommend that you know what you’re paying for! So, let’s look at some common health insurance terms below.
Ready to start understanding what those plan descriptions really say? Here are some scary looking words, broken down.
An allowed amount is the highest dollar amount your provider will pay for a service. If your provider charges you more, you’re on the hook for the difference.
Some plans have coinsurance and some don’t. But it’s the amount, not including your deductible, that you pay for coverage. Generally, it’s a percentage of your medical bill.
As in your insurance may cover 90% of the costs, but expect you to cover that last 10%.
Most Canadian health insurance plans have little to no copay, but it can sometimes happen.
A copay is an amount you pay before leaving the doctors office. In some cases, the insurance will reimburse you for this amount.
If you have a child or a loved one that’s legally in your care, these are your dependents. You can pay more to have them under your coverage umbrella.
These are things that your health insurance will cover that aren’t necessarily medication, but that assist in your health. Things like needles for diabetics or an at home blood pressure cuff for someone that needs it.
You’ll need to have a doctor determine that these supplies are necessary before the insurance will cover them.
This is like an annual checkup or at least like the ones you used to get as a kid. Some plans require that you have an official exam before they’ll agree to cover you.
They use this exam to determine your risk level yet it’s illegal (in Canada) to deny you coverage because of an existing condition.
If you have any other vocabulary questions while you’re reading plan details, be sure to Google the word. If you’re going to put your health in their hands, you deserve to know what you (or your employer) are paying for.
Your plan network refers to the doctors and hospitals that you get coverage at. Some hospitals and doctors offices take a large range of insurance plans, while others only take one or two.
You cannot get services at an out-of-network provider. If you do, you have to pay out of pocket. Most of the time, if it’s an emergency, your insurance will refund you the cost of out of network services.
Now that you have some vocabulary context, let’s talk about telling one plan from the other.
The first thing you want to look at is. . .
Probably the most important thing to look at when you’re buying an insurance plan is the deductible, also called the premium.
This is the amount you have to pay per year no matter what services you used. The higher the premium, usually, the more things the plan covers but not necessarily.
Some plans are more costly than others due to the type of network they’re in.
The first thing you need to ask yourself is if you can afford the premium or deductible. If you can’t, then it’s time to move on to another plan.
In most cases you can pay the premium or deductible over time so you don’t need the chunk of money up front.
Some people are pickier than others when it comes to choosing their care providers. For example, if you’re religious, you may want treatment at a religious-based hospital.
Or you may live in a rural area, where there aren’t many choices when it comes to healthcare providers.
Imagine picking a health insurance network and then finding out you have to drive half an hour just to take your kids to the doctor for school time checkups.
That’s one reason to work with an insurance broker they’ll know things like your network area, so you don’t make any location-based oversights.
Sometimes health insurance companies are a little shady about announcing their copay fees. Most of the time you walk up to the billing counter of your doctor’s office and wait to hear what your copay is.
It’s not practical for the insurance provider to list the copay for each type of visit there are so many.
However, there are plenty of sites that rank plans or insurance brokers that can tell you the general range.
It’s usually a percentage and with some plans, it can be up to thirty percent.
Some people never go to the doctor unless there’s a problem, and they rarely have problems. If you’re one of those people, consider yourself very lucky. Your health is the most precious thing you have.
Other people have diagnoses they’re managing which have them in and out of the doctor’s office all the time.
People who go to the doctor more often are going to spend more, in general, on their health. It’s worth paying more for a more comprehensive insurance plan if you have a more complex health journey.
Haven’t really thought about that? Here are some questions to ask yourself:
All of those questions will let you know what level of coverage you need.
Now, let’s talk about taking all this stress off your back. You’re probably thinking to yourself since when did needing a checkup get so complicated?
Since insurance companies started competing against each other, but that’s not the point.
Hiring an insurance broker involves a fee, but most of the time they’ll save you at least double their rate on your health insurance plan (in the first year).
They’re professionals and they know the ins and outs of each plan they’ve got that vocabulary down pat.
You and your family are different than your neighbor and their family (or maybe they’re immigrants). We’re all Canadian, yes, but we have different medical needs.
When you work with an insurance broker you can tell them details about your family, which they’ll use to pick the best plan for you.
If there are additional services you need, like adding a spouse or dependent, they’re a pro at that.
You won’t have to scan through the insurance providers lengthy website to figure out which forms to fill out. They’ll send them to you and help process them.
If you’re not happy with your plan over time, you can come back and let them know your issues. If the problem is solvable, they’ll help you access the correct resources.
If it’s not, then they’ll help you find a plan that fills in what your current plans lack.
But given their skill in helping find the right plan for everyone, that situation is unlikely.
Whether you choose to work with a health insurance broker or go it on your own, don’t be afraid to ask questions. The insurance provider likely has an admissions line where you can ask clarifying questions.
The best health insurance plan is an important decision so we hope you treat it as such.
And if you need help, we’re always right here, with a free and quick insurance quote tool.
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