Understanding Your Individual and Family Plan Options
As Open Enrollment approaches, it’s a good time to evaluate whether your plan is still working for you or if a change might be needed. If your needs have changed in the past year or you would like to consider another plan, take this opportunity to explore what else is offered in your area. Shop and compare plans at marketplace.viabenefits.com between November 1 and December 15.
Via Benefits works with a range of insurance carriers, both long established and relatively new. While you may not always recognize some carriers, Via Benefits ensures all the plans on our platform are qualified.
Reviewing Plan Options
Getting to know the characteristic of each plan type will help you narrow your choice.
Health plans will:
Cover essential health benefits. These include services such as preventive care, emergency care, outpatient care, mental health, and prescription drugs.
Have a provider network that includes established medical professionals. These medical professionals have agreed to see members under specific rules, including billing at lower rates. Almost all available plans will require you to use in-network providers for the service to be covered (most available plans won’t cover out-of-network services, except in emergencies).
Pay different amounts of your medical expenses. A plan that pays a smaller percentage of your expenses will have a lower monthly premium, while a plan that pays more of your expenses will have a higher monthly premium.
Require a deductible. Just like your car insurance, most plans cover the costs after you've paid a certain amount.
Require cost sharing. Once you’ve met your deductible, you’ll likely be required to pay a portion of the cost of services through coinsurance or copays.
Plan Categories
There are four Individual and Family Plan categories, aka the “metal tiers” — Platinum, Gold, Silver and Bronze. These plans differ based on how you and the plan share the costs of your care, but not on the amount or quality of care you receive. Not all plan levels are available in every area.
Which metal tier is right for you? The Via Benefits website and licensed benefit advisors can help you decide.
Types of Health Plan Networks
Within these plan level categories, you may have different plan types to choose from. The majority of plans available to you will likely be Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).
Typically, HMOs are more affordable than PPOs, though they offer a less extensive network. PPOs tend to provide a broader network than HMOs and the flexibility to see any health care provider in their network.
If you have a PPO and want to pay lower premiums, it’s worth considering whether you are using the wider network of providers. You might be able to save money by selecting an HMO that includes your preferred providers.
Protection Plans
Protection plans are a cost-effective way to manage unexpected out-of-pocket costs or expenses from a medical event. Read Get Peace of Mind with Protection Plans to learn more.
Did you know?
Standardized plan options help simplify comparison shopping by focusing on premiums and network differences. Contact a licensed benefit advisors to learn more.
Snowbirds Take Note
If you live in more than one place during the year or travel frequently, keep the following in mind:
Your plan will cover care at in-network rates for true emergencies regardless of where you are.
For non-emergency care, an HMO with a narrower network of providers may not cover you in all the places you travel.
If available, a PPO might be your best option because you can see out-of-network providers.
Look for a plan in the region where your primary providers are.
You may be able to use your regular provider’s telehealth options when traveling.
To view all the options available to you, add your preferred doctors to your Profile before searching for plans. This enables you to see all the plan options in your area that include your in-network providers.