How to Shop for Health Insurance

Small Employer Health Insurance Tax Credit
January 31, 2020

How to Shop for Health Insurance

How to Shop for Health Insurance


The first thing you should check is the network…. which providers are in the network. Here’s an explanation of the kinds:

PPO = Preferred Provider Organization – You don’t need referrals to see specialists (therapists, dermatologists, etc.) and usually the network is large & national. So you may be able to go to top tier facilities such as Sloane Kettering in NYC for cancer, Mayo Clinic in Minnesota, or a substance abuse treatment facility in Florida.

HMO = Health Maintenance Organization – You’ll need a primary care physician (PCP) and need referrals to see specialists. The network is usually smaller and limited to your geographic area. If you go out of the network, you will have to pay for the entire cost of medical services.

POS = Point of Service – It’s an HMO but with an out of network benefit. The out of network benefit is usually not great… but it’s a back stop in case something happened where you did need to to NYC or Florida to receive care.

EPO = Exclusive Provider Organization – Basically a PPO with no out of network benefit.

The second thing you should check is the deductible: https://www.healthcare.gov/glossary/deductible/ Often the deductible doesn’t apply to all services… usually just higher cost services like hospitalizations. You can think of it like this, about 50% of your premiums is for rare occurrences like hospitalizations and outpatient surgeries. If you want lower health insurance premiums… that’s where you’ll move the needle. About 25% is for doctor visits & lab tests / diagnostics. Then the last 25% is for prescription drugs. That’s a very rough accounting, but if you want to lower your insurance premiums… that’s a good way to think about it.

What is a deductible?

What is a copay?

What is coinsurance?

What do medical procedures cost?

How to find a good doctor?

Zocdoc doctor ratings?