Choosing the right health insurance plan can be overwhelming, but it’s a critical decision that impacts both your health and finances. At Shrestha Insurance Agency, we specialize in helping individuals, families, employers, and seniors navigate the complexities of health coverage. Here’s a guide to simplify your search and ensure you find the right health insurance plan that meets your needs.

1. Understand Your Needs

Before comparing plans, assess your healthcare needs. Consider factors such as:

• Frequency of doctor visits
• Prescription medications
• Chronic conditions or ongoing treatments
• Preferred doctors or healthcare providers
• Budget for premiums, deductibles, and out-of-pocket costs

2. Know the Different Types of Plans

Health insurance plans come in various types, each with its pros and cons:

• Health Maintenance Organization (HMO): Requires using in-network providers and selecting a primary care physician (PCP) for referrals.
• Preferred Provider Organization (PPO): Offers more flexibility in choosing healthcare providers, including out-of-network care at higher costs.
• Exclusive Provider Organization (EPO): Covers only in-network services except in emergencies.
• High-Deductible Health Plans (HDHP): Pairs with Health Savings Accounts (HSAs) to save on taxes while covering qualified medical expenses.

3. Compare Costs Beyond Premiums

While premiums are important, other expenses play a role in your total healthcare costs:

• Deductibles: The amount you pay before insurance starts covering expenses.
• Copayments & Coinsurance: Your share of costs for services after meeting the deductible.
• Out-of-Pocket Maximums: The most you’ll pay in a year before insurance covers 100% of additional costs.
• Can you get A Marketplace subsidy to help pay for the plan?

4. Check Provider Networks

If you have preferred doctors or specialists, ensure they’re in-network. Going out-of-network can significantly increase costs.

5. Review Prescription Drug Coverage

If you take medications regularly, check the plan’s formulary (covered drug list) to confirm your prescriptions are included and affordable.

6. Explore Additional Benefits

Some plans offer wellness programs, telemedicine options, dental, vision, or alternative therapies that may be beneficial for your needs.

7. Consider Your Enrollment Options

You can enroll in health insurance during Open Enrollment or qualify for a Special Enrollment Period due to life events like marriage, having or adopting a child, job loss, or relocation. Medicare beneficiaries have their own enrollment periods. If you have any questions about Medicare, please reach out to us so we can help answer any of those questions.

8. Seek Expert Guidance

Navigating health insurance can be complex, but you don’t have to do it alone. Shrestha Insurance Agency is here to help you compare options and find the best coverage for your needs.

Contact us today for a free consultation and take the stress out of finding the right health insurance plan!

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