What Are My Options for Family Health Insurance?5 min read • March 18, 2019
When you’ve got a family, their health is usually at the top of your list.
The vast majority of those with health insurance are either covered at work, by their spouse’s employer, have purchased individual policies or they qualify for government-provided health care (Medicaid and or CHIP).
However you choose to be insured, there are many choices to make when it comes to getting the best healthcare for your money. Let’s explore these options so you can make an informed decision that fits your family’s needs and stays within your budget.
Types of Health Insurance Plans
Insurance plan options may seem almost endless. However, the most common types of plans can be grouped into one of the following categories:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Indemnity or Fee-for-Service Plans
Let’s look at each of these categories and the good and bad that come with each type.
Health Maintenance Organizations (HMOs)
A Health Maintenance Organization or HMO is a group of healthcare professionals and medical facilities who come together to offer specific healthcare services for a fixed price.
Each patient with an HMO plan has a primary care physician (PCP). The PCP’s within HMOs must determine when a specialist is needed. Specialist services are not covered unless an in-network referral is made. With HMO plans, all your care is coordinated by your PCP.
The main advantage of HMO plans is that your out-of-pocket costs are typically lower and more predictable than other insurance plan types.
A disadvantage of HMOs is that care from out of network healthcare professionals is usually not covered, except in an emergency. Additionally, specialist services require a referral from your PCP, which may require an extra doctor appointment. Some find it difficult to get the care they need because it is not covered under an HMO or their PCP won’t issue the necessary referral.
Preferred Provider Organizations (PPOs)
A Preferred Provider Organization has the managed care aspect of an HMO with the added benefit of flexibility. Within a PPO, you can choose to see any health provider of your choice. There is one small caveat to this, your benefits will be less, and you’ll pay more out of pocket than if you stay in network, but you get to see the healthcare providers you want. If provider choice is important to you, a PPO is likely a good choice if available.
A primary advantage of PPOs is the ability to choose the healthcare providers you want to see.
Because you have flexibility in which healthcare professionals you see, it can be hard to predict your out-of-pocket expenses, as prices vary depending on whom you see.
Indemnity or Fee-for-Service Plans
Indemnity or Fee-for-Service plans are traditional plans that let you see any doctor or specialist you choose without having to get a referral. The insurance company pays a set portion of your charges, and you pay the rest. Overall, indemnity plans are the most flexible of the options as there are no provider restrictions. These plans are getting hard to find and are typically quite expensive.
The most significant advantage of Indemnity plans is that you can see any provider you want without having to get referrals or prior approval.
A couple of disadvantages to these plans include the fact that Insurance companies often shift costs to you through higher premiums and deductibles to manage costs, making these plans more expensive than HMOs and PPOs. Also, you may have to pay for healthcare services up front and submit a claim for reimbursement, which ties your money up without the guarantee of getting it back.
In addition to health insurance plans, healthcare savings account options are available, including Health Savings Accounts (HSAs), Flexible Spending Accounts (FSA) and some employers offer Health Reimbursement Accounts (HRAs). Each of these accounts has specific rules and requirements, and are a great way to help save pre-tax money to help pay for healthcare costs.
Where Can I Get Health Insurance?
Many obtain health insurance through their job or their spouse’s employer. However, many small employers aren’t able to offer health insurance. If your employer doesn’t offer insurance, you may be able to get coverage through a labor union, professional association or other organization.
If you cannot find suitable group coverage, you can purchase an individual policy. You can search on the Affordable Care Acts site, Healthcare.gov, to find and compare policies from your state’s marketplace and see if you’re eligible for subsidies to help offset the costs.
You can also purchase health insurance from an insurance carrier or broker, known as off-exchange plans.
Faith-based healthcare is another option to consider. While these plans are not health insurance per se, the plans offer a cost-sharing approach to pay for healthcare costs. There are several faith-based options out there, so you’ll need to read the fine print very carefully to make sure you know all the in’s and out’s.
Government Provided Healthcare
In addition to employer-sponsored health insurance and purchasing individual plans, there are government provided healthcare options available to those who qualify. Let’s cover two types of coverage available, Medicaid and CHIP.
You may qualify for low-cost or free care through Medicaid based on income and family size.
Medicaid provides health coverage for some low-income people, pregnant women, families, children, and those with disabilities in all states. Medicaid covers all low-income adults below a certain income level in some states.
To see if you qualify for Medicaid coverage, check out the U.S. Department of Health & Human Services site.
Children’s Health Insurance Program (CHIP)
If your children need health coverage, they may qualify for the Children’s Health Insurance Program (CHIP). CHIP provides affordable health coverage to children whose family earns too much to qualify for Medicaid. CHIP also covers pregnant women in some states. You can see if you’re eligible for CHIP here.
There are many ways to obtain health insurance for your family. Be sure to consider all the possibilities when choosing your coverage to make sure you get the best healthcare and the most value for your money.