How to choose the best employer-sponsored health insurance plan for you
When your employer tells you it's time to choose your health coverage for the year, how do you choose the right plan? It’s a bigger decision than you may think. Learn more about the types of employer-sponsored health insurance plans your employer may offer, and the plan design factors that impact your out-of-pocket costs, the way you access providers and how your plan works day to day.
Why choosing the right health insurance plan is important
The “right” plan for you is the plan that best fits your health needs and budget. Understanding how each plan type works and choosing the best plan design for your needs ensures you can get care when and where you need. Plus, it helps you manage your health care spending and avoid unexpected costs.
Even if you’re already a Wellmark member with an employer-sponsored health plan, it’s important to review your benefits every year to make sure they still fit your health needs for the upcoming year. Here are some of the plan designs your employer may offer and what to consider when choosing a plan.
Employer-sponsored health insurance plans from Wellmark
Your employer chooses which health plans they would like to offer to employees. And depending on your employer’s funding arrangement, some — like self-funded employers — can determine which providers are in-network and which prescription drugs are covered by your pharmacy formulary. While your employer may not offer all these options, understanding how they work can help you choose the best fit for your needs.
Wellmark’s broad provider network offers a full range of specialties across Iowa and South Dakota — as well as options for high-quality virtual care and mental health support. Preventive care is also fully covered under most plans when you use an in-network provider. Plus, many employer-sponsored plans include no-cost extras like case management services for severe or complex health conditions, digital health and well-being tools through Wellmark Connect powered by WebMD, our 24/7 nurse line and more.
Get to know your employer-sponsored health plan benefits
Knowing what your benefits are and how they work can help you feel more confident using them. View your benefit details in myWellmark®.
Types of employer-sponsored health insurance plan designs
Wellmark plans are designed from a variety of tiers, deductibles, coinsurance, out-of-pocket maximums and benefits. Wellmark offers several types of employer-sponsored plan designs. Here are three common plan designs your employer may offer.
Traditional plans
With this plan, you’ll pay copays for common health care services like office visits. For other larger expenses, deductible and coinsurance may apply.
Modified plans
These plans have a straightforward, tiered copay design. There’s no deductible or coinsurance. You have a set copay that’s dependent on the service you receive, so you’ll know what you’ll pay ahead of time. And, all copays go toward your out-of-pocket maximum.
High-deductible
This plan design offers some of the lowest monthly premium costs. With this plan, you’ll pay the full cost of care for everything but preventive services until your deductible has been met. This plan design is compatible with a health savings account (HSA), which allows you to contribute to, invest in and use funds to pay for qualified medical expenses tax-free.
Network and employer-sponsored health insurance plans
Your plan’s network impacts the cost of your care, the providers you see and how you can access them. Here are some of the plan options you may see when selecting your employer-sponsored health coverage.
Wellmark Blue HMOSM
The Wellmark Blue HMO — health maintenance organization — plan reduces costs by only offering coverage for care from in-network providers and facilities. It also reduces costs by requiring a designated primary care provider (PCP) to help manage your care and refer you to other in-network providers. HMO plans typically only cover out-of-network care in emergencies.
What choosing this plan means for you: You’ll generally have lower premiums and out-of-pocket costs, but your PCP will need to refer you to specialists and — in most situations — you’ll need to stay in-network for your care to be covered.
Wellmark Blue PPOSM*
PPO — preferred provider organization — plans offer broad coverage and flexibility in where and who you can receive in-network care from. While we still recommend designating a PCP for regular preventive care, PPO plans don't require it. You can see many specialists without a referral. Your PPO plan will pay a portion of your out-of-network care, but your out-of-pocket care costs will be lower if you stay in-network.
What choosing this plan means for you: You’ll have more flexibility to see the providers you want without a referral, but you may also have higher out-of-pocket costs.
Wellmark Blue POSSM*
POS — point of service — plans combine features of both HMO and PPO plans. You’ll need to designate a primary care provider (like an HMO), but you have the option to see any in- or out-of-network provider (like a PPO). Even with the option to see out-of-network providers, you’ll be responsible for a portion of out-of-network charges and save when you see in-network providers.
What choosing this plan means for you: You’ll have a balance of coordinated care and network flexibility. Your costs will vary depending on how you choose to access care.
HMO vs. PPO: Which health insurance plan option is right for you?
The main differences between HMO and PPO plans are the flexibility to see out-of-network providers and the amount of out-of-pocket costs. When considering which plan option is right for you, you’ll want to think about which plan will best connect you to the care you need and fits your budget. Be sure to consider your preferences around referrals, the providers you want to see, the care you anticipate needing in the year ahead and what out-of-pocket costs you’re comfortable paying.
Finding in-network care for Wellmark members
Avoid surprise bills by staying in-network. Check to see if your current providers are in-network or find a new in-network provider near you. myWellmark®, our secure member portal, makes it easy to search for providers, check your benefits and track your health care spending. If you aren’t registered for myWellmark, register today. It only takes two minutes.
Get help choosing an employer-sponsored health insurance plan
Have questions about the types of health insurance plans, in-network benefits or choosing an employer-sponsored plan? Current Wellmark members can call the number on the back of your member ID card. You can also call Wellmark Customer Service at 800-524-9242 (TTY: 888-781-4262), Monday–Friday, 7:30 a.m.–5 p.m., Central Time. Or talk with your employer’s benefits administrator.
Disclaimers
*These plan options are only available through select employers.