This article was last updated on June 26, 2023.
When you're choosing your own health insurance for yourself or your family, you are likely looking for an affordable monthly premium. You also want to pay less out-of-pocket when you receive health care without compromising on quality. Here, you'll find a few tried-and-true strategies to help you find a plan that fits your needs and your budget.
If you are new to health insurance, take a moment to understand a few important insurance terms.
How to keep your health care costs down
When choosing health insurance, it's important to think through the specific health care needs of yourself and your family. For example, do you visit the doctor often? Do you or your family members have any health care needs that require a specialist? Do you take any high-cost prescription drugs? This will help you narrow down your choices. Then, consider these cost-saving strategies:
- Determine if you are eligible for a subsidy
- Consider an HMO
- See an in-network provider
If you buy your own health insurance, you may qualify for a subsidy that's also known as a premium tax credit External Site. This is a sum of money provided to you by the government that can be used to lower your monthly premium. You may also qualify for cost-sharing reductions External Site, which help you pay less out of pocket each time you get medical services. These amounts are determined by your household size and income, which is why it’s important to be as accurate as possible when filling out your application and report any income or household changes each year on Healthcare.gov External Site.
If you’re looking for quality health care that’s less expensive than traditional plans, consider a health maintenance organization (HMO) plan. With an HMO, you will select a primary care provider (also known as a PCP) who can refer you to specialists within the network for specialty services. HMOs negotiate lower rates with specific health care providers in your state, and the savings is passed on to you with less expensive monthly premiums and other out-of-pocket costs.
There are many common misconceptions about HMO networks. Wellmark Blue Cross and Blue Shield makes staying in-network easy, as our state-based HMO network provides members with access to health care providers across the state and access to emergency care nationwide.
New plans for Iowa
While we already offer a variety of plans to fit your needs and budget, Wellmark has partnered with UnityPoint Health to offer new HMO plans in select counties in Iowa.
Staying in-network helps you avoid surprise health care costs. Wellmark has negotiated agreements with in-network doctors and hospitals to ensure you have access to high-quality care. Regardless of your network, staying in-network can help you save.
- If you are on an HMO plan, seeing an in-network doctor ensures your services are covered and you will not be billed for the cost of services beyond your copays.
- If you are on a PPO plan, you can see any doctor you want, but will you pay less if you see an in-network provider. A doctor outside of Wellmark's provider network may bill you for the difference in their charge and what Wellmark pays, resulting in higher costs for you.
If you have a solid understanding of your future medical needs or plan to use a health savings account (HSA) to pay for your care, then a high-deductible health plan may be a good choice for you. With this type of plan, you will pay lower monthly premiums in exchange for higher deductibles and out-of-pocket costs. Because you are responsible for the full cost of care until your deductible is met (excluding preventive care), this type of plan encourages you to have meaningful conversations with health care providers to determine care options and cost-savings opportunities.
New plans for South Dakota
Wellmark is offering new, comprehensive coverage options in select counties in South Dakota with several plan type options.
Certain plans, like high-deductible health plans, can be paired with an HSA External Site. These are special savings accounts you use just for health care expenses.
With an HSA, you set aside pre-tax money to pay your medical, dental and vision expenses. You can decide how much you want to contribute annually, as long as it equals or is less than the contribution limit the IRS sets for HSAs each year. If money is still in your account at the end of your plan year, it will automatically carry over. Any balance in an HSA stays with you, regardless of changes in employment, insurance carrier or retirement.
Plans that pair with a health savings account have higher deductibles, so their premiums are lower.
Get more from your health plan
Wellmark plans include a variety of programs that give you more value for your money:
- Low or no-cost coverage for virtual care visits with Doctor On Demand® External Site.
- Around-the-clock health assistance through BeWell 24/7SM.
- Discounts on gym memberships through Blue365® External Site.
- Personalized member website with easy-to-use tools to help you manage your health plan benefits, claims and more.
Doctor On Demand physicians do not prescribe Drug Enforcement Administration-controlled substances, and may elect not to treat conditions or prescribe other medications based on what is clinically appropriate.
For plans that include benefits for mental health treatment, Doctor On Demand benefits may include treatment for certain psychological conditions, emotional issues and chemical dependency. Services performed by Doctor On Demand psychologists are covered. For more information, call Wellmark at the number on your ID card.
Doctor On Demand by Included Health is a separate company providing an online telehealth solution for Wellmark members. Doctor On Demand® is a registered mark of Doctor On Demand, Inc.
Blue365® is a discount program available to members who have medical coverage with Wellmark. This is NOT insurance.
Blue365® is a registered mark of the Blue Cross and Blue Shield Association.