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How to Choose the Right Health Insurance: 6 Things to Look For

health insurance notepad

As policy costs decrease and tailored solutions begin to dot the market, Americans’ satisfaction levels with health insurance costs and coverage quality have reached a new high. Nonetheless, millions of people still struggle to find a coverage type that fits their unique financial and health needs, causing them to delay or skip important treatments. 

But, with over 5,650 health insurance companies serving the nation, improving your experience as a patient is all a matter of learning what to look for in the best policy for your needs. 

Start by ticking the boxes below. 

A Seamless Claim Process

When experiencing a medical emergency or recovering from a surgical procedure, the last thing you’ll want is to deal with a complex claim filing process and long waiting times.

However, today, some insurance providers take 30 days or more to process a claim, and some policies include a waiting period that can stretch from 9 months to several years. 

Before selecting a certain insurance plan, review the provider’s customer service and examine your policy to understand how long you’ll have to wait before you can submit a claim. Don’t forget to ask your provider for clarifications on how to file a claim. 

Is Maternity Cover Included? 

In the US, giving birth costs, on average around $5,000 to $10,000 for a delivery without complications, and this cost can skyrocket to over $30,000 when considering potential complications and postpartum care. 

So, if you are looking to make the right choice with your health insurance policy, you should look into add-ons and additional coverage, including maternity benefits and outpatient care during pregnancy.

Pro tip: Most policies apply a waiting period to maternity benefits, usually standing at around 9 months, during which you won’t be able to claim pregnancy and delivery expenses. Make sure to account for this aspect if you are planning to become pregnant. 

Policy Premium, Costs, and Maximum Coverage

On average, health insurance in the US costs around $450 per month for individual plans, and around $1,152 for a family policy. However, thanks to the broad availability of different policies, individuals can easily find coverage that reflects their budget and health needs. 

Some of the costs and benefits to look at include:

  • Monthly premium
  • Copay structure
  • Coinsurance 
  • Out-of-pocket expenses and maximum
  • Deductible amount
  • The maximum sum paid in the event of a claim

In-Network Providers and Facilities

Whether you have been relying on a trusted physician for years, or you are still looking for the right healthcare provider for you, it is important to choose an insurance plan that serves a wide range of in-network facilities and providers. 

Depending on the type of insurance you have, you might only be able to access out-of-network providers in an emergency or by paying much higher costs for treatments and care. Ideally, you should opt for a policy that guarantees accessible care in 5,000 or more medical facilities across the nation. 

Coverage for AYUSH and Emerging Treatments

Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) treatments – often referred to as alternative or non-allopathic treatments – have been used for millennia.

But it was only during the Covid-19 pandemic that studies proved their effectiveness in delivering better health outcomes and reducing a country’s disease burden. 

In turn, health insurance providers are responding to this healthcare trend by expanding coverage to AYUSH treatments and brand-new technologies (i.e.: robotic surgery and stem cell treatments). 

While a lot is yet to be understood about these alternative treatment plans, the body of research is in constant growth. Opting for an insurance policy that goes beyond allopathic treatments can give you access to a much greater choice of treatments. 

Coverage for Pre and Post Hospitalization

Insurance plans focus on covering medical procedures and treatments. However, you might be running into other costs before and after your visit to the hospital or emergency room, including doctor bills, follow-up appointments, prescription medicines, and checkups. 

Make sure to choose an insurance policy that covers both inpatient and outpatient treatments for the entire course of your condition and allows you to access uninterrupted care.