This post is sponsored by PolicyGenius-but guess what?-we already had a crush on them. We’ll only recommend products we believe in-including in sponsored content. Rest assured, PolicyGenius is one of them!
Would you buy a car without knowing its predicted fuel economy, performance specs, or safety ratings? What about a house without knowing the mortgage rate, property taxes, or association fees? Probably not.
And yet, most of us buy health insurance every year without fully understanding our plan’s critical details (for example, the deductible, co-pay provisions, out-of-network maximum and more).
Too often, we buy a health insurance plan simply because it’s the cheapest without understanding what we’re getting-or, most likely, not getting.
Only when you go to use your insurance do you find out that something isn’t covered-or that you can’t even see your own doctor. Imagine you buy a car only to discover it will only run on a particular brand of gas!
The online insurance marketplace PolicyGenius is changing all that with its new approach to comparing and buying health insurance online.
Meet PolicyGenius Health Insurance
Founded in 2014, PolicyGenius began by giving consumers an easier way to compare life insurance rates and purchase a policy, entirely online. That was a disruptive idea in an industry driven by commissioned salespeople that had little online presence.
Today, PolicyGenius hopes to do the same with health insurance, stripping away the complexities involved in comparing plans and cutting through the jargon with overviews of plan benefits written in plain English. If the insurance companies won’t let you compare apples to apples, PolicyGenius will at least show you what’s similar, and what’s different, between an apple and an orange.
In the screenshot below, you can see the beginning of three plans compared on PolicyGenius. Each row contains a different benefit category for health insurance plans so you immediately pick up the differences among the plans you choose to compare.
This is more important than you might think.
Comparing health insurance plans with PolicyGenius
While it’s relatively easy to compare monthly premiums, deductible and out-of-pocket maximums, health insurance plans have other nuances that can add up to big differences in your annual healthcare costs. PolicyGenius makes it easy to compare more than 30 different costs and benefits.
Let’s look at some common examples.
Primary care visits
If you’re quite healthy, your entire healthcare needs might consist of a check-up every few years and a doctor to visit when you’ve got the sniffles. While some plans offer copays as low as $20 for primary care visits, others make you pay full price for the visits before your deductible. That’s a big difference.
There are in-betweens as well. For example, under my last plan there was a $40 co-pay for the first three primary care visits of the year. After that, I had to pay full price.
Certain preventative care services are free under federal law, but not as many as you think. Be careful: If you go in for something covered under preventative care but happen to mention another issue, you could receive two bills for the same visit.
We got a surprise last year when our son had an ear infection and my wife took him to a Mercy Hospital urgent care facility around the corner. It was the weekend, and far easier than waiting until Monday and taking off work to take him into the city to his regular pediatrician.
As it turns out, the urgent care facility didn’t accept our Anthem insurance. That came as a shock. There are only four insurance companies serving Maine and two primary hospital chains. It’s something we didn’t research at all-we just assumed a major insurer like Anthem would include one of the only major hospital chains in our area. Not so.
Since we already had a high deductible, we went ahead with the visit anyway and just paid the bill. I am just so grateful everyone stayed healthy and we didn’t have to deal with any large insurance claims.
The moral: Take a few extra minutes to find out which providers are included or excluded from your chosen health insurance plan. PolicyGenius makes this easier because you can enter the names of your preferred doctors and it will tell you which insurance companies have them in their networks.
HMO vs PPO
In 2016, my wife and I were both self-employed and purchased our own health insurance. Unfortunately, PolicyGenius’s health insurance product wasn’t around yet, so we had to compare plans on our own!
We paid about $850 a month for a Bronze Anthem HMO with a high deductible-one of the least expensive unsubsidized plans in Maine for a family. (Fortunately, we’re healthy and had the savings to deal with the deductible in the worst case scenario).
But we didn’t know how difficult the HMO would make our lives.
With an HMO, you must select a primary care physician (PCP) and obtain a referral from that PCP prior to seeing any other healthcare provider. It doesn’t matter, for example, if you’ve been seeing the same specialist every two weeks for years. Without a referral, your insurance will deny any claims.
Getting a referral is a pain but manageable, but only if your insurance company cooperates. In our case, Anthem never could get our PCPs straight.
For whatever reason, Anthem kept changing our PCPs in our accounts so that they denied every claim-even for visits to our own primary care doctors!
Maddeningly, Anthem won’t let you change your PCP on their website, so we spent hours on hold only to have the customer service reps screw up the change three different times. They would correct one family member’s account only to mail new ID cards indicating wrong PCP on someone else’s cards. It’s been a nightmare.
Fortunately, this is only my story. It doesn’t mean you’ll have the same experience with an HMO. But just like your health insurance company’s network-the steps you must take to access care is an important factor to consider.
Ambulances and ER visits
The average cost of a trip to the Emergency Room was $1,233 according to a 2015 study. If you need an ambulance to get there, you can expect to pay another $500 to $1,000 for the ride.
While heading to the ER is often the most expensive way to access healthcare, sometimes it’s unavoidable. Unless you have a top-of-the-line policy, expect to pay 100 percent of the bill for an ER visit before you meet your deductible. After you meet your deductible, policies differ quite a bit. With some, you’ll have to pay between 20 and 50 percent of the bill. With better plans, you’ll have a fixed copay.
With average plans, you’ll be responsible for 100 percent of any ambulance bills before your deductible. Better plans will pay up to 80 percent of an ambulance bill, even before you meet your deductible.
Mental health visits
Routine counseling or therapy sessions are good for everybody, but the costs add up quickly if you have regular sessions. With better plans, you’ll only pay a co-pay for outpatient mental health visits. Less-desirable plans will make you pay the entire bill before you meet your deductible.
The best plan for you might depend on whether you have ongoing prescription needs. Before showing you plans, PolicyGenius asks if you need specific medications and will flag any policies that don’t cover them. Most policies will make you pay full price for brand-name drugs if generics are available. Compare carefully.
If you expect to be expecting, pay attention to hospitalization coverage and delivery benefits.
While the Affordable Care Act mandates insurers fully cover some prenatal visits and breastfeeding support, you’ll need to pay for all or most of delivery expenses under most plans. The cost can easily reach several thousand dollars for a routine delivery. Whichever plan you choose, start saving!
Buying health insurance is overwhelming, but getting easier
PolicyGenius really does make comparing and buying health insurance easier-there are only 5 steps.
As I compared health insurance plans on PolicyGenius earlier this month, I appreciated the ability to filter plans by the things that mattered most to me, as well as some helpful advice integrated into the comparison process.
After providing my basic information, the site asked me to both define my budget and prioritize coverage benefits.
I divided certain benefits into “must-haves” and “nice-to-haves”. I thought that was awesome, because those priorities are going to be different for everyone.
For me, after a horrific experience with an HMO, the ability to go to any in-network doctor was important. Of course, when I got to the comparison page, I realized I would need to pay extra for that benefit. I know it’s impossible to have everything you might want in one healthcare plan, but PolicyGenius makes it easy to compare plans side by side based upon your own priorities and quickly spot the differences.
The process is so good, in fact, that I had a plan picked out in about 5 minutes. Even better, I clearly understood the benefits and costs of the plan. (If you’ve ever looked through the benefits booklets insurance companies typically provide, you could read them for an hour and still not understand your coverage!)
I also felt good that PolicyGenius was helping me choose the plan that was best for me-not one that’s recommended by a generic algorithm. Best of all, my wallet was happy because I found plan options that were less expensive than ones I had seen before.
If you don’t believe me, test drive it yourself. To get quotes, you’ll just need to enter the following information.
- Your age, sex, and whether or not you use tobacco
- Your income (to check for available federal discounts)
- Your desired monthly budget
- Your desired annual deductible
- Your preference to be able to book specialists directly (HMO vs PPO)
- Preferred doctors
- Current prescriptions
- Which features matter most (must-haves vs. nice-to-haves)
Note that you don’t need to create an account or provide your email just to compare plans.
When you’re done, PolicyGenius shows you all of your available options. You can choose two or three plans to compare side-by-side at any time.
During the comparison, PolicyGenius flags certain plans as “Easy Enroll”. When that button is displayed, you can purchase that plan online, right through PolicyGenius’ website. PolicyGenius shows all available options, the most available anywhere online, even if you can’t enroll through their site.
Open enrollment-the annual period when anyone can buy a new health insurance policy-ends on Tuesday, January 31st. If you’ve been putting off buying health insurance or are thinking about doing without despite the federal penalty, it might be time to reconsider.
Health insurance may still be expensive, but at least you’ll know what you’re getting for your money.
Learn more: Compare health insurance at PolicyGenius now