How Do I Choose the Best Teacher Health Care Plan?

Most educators are offered several health insurance options through their school district or state. Still, knowing which teacher health care plan is right for you can be difficult. You want to adequately plan for upcoming medical expenses without shelling out more than you need for premiums.

When you’re looking at different teacher health care plans, there are several things to consider. Keep in mind that there is no “best” option. Your plan should reflect the things that are unique about your financial and medical situations.

Should I go with my employer plan or shop around?

Personally, I’m a believer in shopping around to get the best deal available in all situations. Teacher health care plans are no different. You should make sure that the coverage offered by your employer is the best bang for your buck.

However, in most cases, getting health care coverage through your employer is, in fact, your best option. The costs are typically lower as your employer has negotiated a lower premium rate and often picks up part of the premium. Still, it never hurts to look around. Do some comparison shopping between the health care plans offered through your employer and the Affordable Care Act marketplace to see which better matches your needs and your budget.

Compare available networks.

Every insurance network provides different benefits to plan participants, and your employer options may provide more than one insurer for you to choose from. You should look at what health care professionals and providers are in-network for each different insurer. You may find that in your area more health care providers work with one particular insurance network over another, or it may not matter as all providers accept all insurers.

Understand plan types.

There are a limited number of plan types within any given insurance network. Here’s a quick overview of the most common types:

• An HMO typically provides all the health-related services you need through a specific network of health care facilities and providers. HMOs can sometimes limit the choice you have when it comes to selecting a provider. They also require that your primary care physician refers you to specialists when needed.
• PPOs allow you a bit more flexibility to choose your providers, and you don’t need a referral from your primary care physician to see a specialist. However, they also have high out-of-pocket costs to see any providers or specialists who are out of network.
• EPOs have no coverage for out-of-network providers, normally have lower premiums than PPOs, and you have some freedom to select your providers.
• POS plans blend HMOs and PPOs. You have some freedom to choose health care providers, some paperwork to see providers who are out of network, and your primary care doctor coordinates your care (which means they refer you to specialists).
• Finally, HDHPs are a type of coverage plan that falls under the umbrella of either HMOs, PPOs, EPOs, or POSs. They have higher out-of-pocket costs, and when you reach your out of pocket maximum, the plan pays for 100% of your care.

Look into your crystal ball.

No one can predict the future, but when it comes to picking the ideal health care plan for you, you need to do some forward thinking. For example, if you have children who have to visit the doctor regularly or enjoy playing on the jungle gym—you may want to consider a plan with lower copays for emergency room or wellness visits.

Alternatively, if you’re planning to see out of network specialists for some of your medical needs, a PPO may be better than a HMO for you. That way you don’t always need to visit your primary care physician for a referral. Everyone’s medical situation is unique and trying to determine the kind of care you need in the future isn’t easy. The good news is that you can always change your benefit selection during the next open enrollment period. So, you really only need to “predict” for the next year or so.

Whichever plan you choose, make sure that it provides the coverage you need at a budget-friendly cost.

Know what monthly premiums are and whether or not they make lower copayments for frequent doctor visits worth it. Understand what coverage you have, and what you can expect to pay for in network and out of network services. Finally, make sure the providers you trust are in network (or are partially covered if they’re out of network). There are many health care plan options available to you—don’t be afraid to take your time to find the one that’s the right fit!

Do you have any advice to share about choosing teacher health care plans? Come and share in our WeAreTeachers Chat group on Facebook.