Find the Best Health Insurance Companies for 2025

Choosing the right health insurance provider is critical for managing costs and ensuring you have the necessary coverage. Many Americans obtain insurance through their employers or the Health Insurance Marketplace. Therefore, it is important to explore the available options. In this blog, we will review the top health insurance companies, focusing on coverage options, pricing, customer satisfaction, and other essential factors to assist small businesses in selecting the best health insurance for their needs.

How to Select the Best Health Insurance Plan for Your Unique Needs?

Finding the right health insurance for your small business involves a few straightforward steps:

1. Assess Your Healthcare Needs: Reflect on how frequently you and your employees visit healthcare providers, current medications, and particular health conditions requiring attention.

2. Evaluate Available Plans: Get to know the different plan types—such as EPOs, HMOs, and PPOs—and understand how they work, along with their advantages and disadvantages.

3. Compare Health Insurance Plans: Carefully review the plan benefits, deductibles, copayments, out-of-pocket expenses, and premiums. Make sure you know what each plan covers and what it doesn’t. Marketplace plans provide summaries of Benefits and Coverage (SBC) to make comparisons easier.

4. Verify Network Coverage: To avoid costly out-of-network charges, ensure that your preferred doctors and healthcare facilities are included in the network of any plan you are considering.

5. Check Prescription Coverage: If you or your employees take prescription medications, verify that the plan covers them and understand the potential out-of-pocket costs. You may need to reach out to the insurance company for specifics.

6. Look for Extra Benefits: Consider additional features that might benefit your team, such as telehealth services, a 24/7 nurse hotline, or wellness program discounts.

7. Ask for Reviews and Recommendations: Speak to the CBC Health Insurance Marketplace experts for guidance on selecting the best health insurance options for your needs.

H2- What Does Health Insurance Cover?

Health insurance plans available through the CBC Health Insurance Marketplace, which comply with the Affordable Care Act (ACA), are required to include ten essential benefits:

1. Ambulatory Patient Services refer to outpatient care, including visits to doctors and specialists.

2. Chronic Disease Management and Preventive Services involve ongoing care for chronic conditions and wellness services to maintain overall health.

3. Emergency Services provide coverage for emergency room visits and related treatments.

4. Hospitalization encompasses surgical procedures and overnight stays in hospitals.

5. Laboratory Services include tests and diagnostics that are necessary for monitoring health.

6. Mental Health and Substance Use Disorder Services offer support for individuals facing mental health issues and treatment for substance abuse.

7. Pediatric Services cover dental and vision care specifically for children.

8. Pregnancy and Maternity Care includes services related to pregnancy, childbirth, and newborn care, as well as breastfeeding support.

9. Prescription Drugs entail coverage for necessary medications.

10. Rehabilitative and Habilitative Services support recovery from injuries and assist in managing disabilities.

The specific services covered may vary based on state regulations. Some plans might offer adult dental or vision coverage and programs that assist with diabetes or weight management. For individuals 18 and younger, dental coverage is considered an essential benefit under ACA-compliant plans, meaning it must be available either as part of a health plan or as a separate dental plan. However, adult dental care is not classified as essential, so it may not be included in your health insurance, depending on the specific plan.

It's also important to note that benefits can vary by insurance company. Always read the details carefully to understand what each health insurance plan covers and excludes, ensuring it meets your small business's and your employee's needs.

What Does Health Insurance Not Cover?

Understanding what health insurance does not cover is as important as knowing what it includes. This knowledge can help small business owners and employees avoid unexpected costs and ensure they choose the right plan. Here are some common exclusions you might encounter:

1. Alternative Therapies: Treatments such as acupuncture and chiropractic care are often only covered if explicitly included in your plan.

2. Cosmetic or Elective Procedures: Procedures considered cosmetic or elective, like plastic surgery for aesthetic reasons, typically won’t be covered.

3. Dental and Vision Care: These services are generally excluded unless your health plan specifically offers them as part of the coverage.

4. Experimental Treatments: New or experimental treatments not widely accepted in the medical community are usually not covered.

5. Medical Care Outside the U.S.: Most health plans do not cover medical expenses incurred while traveling abroad.

6. Non-Essential Medications: Drugs that aren’t FDA-approved or are deemed non-essential are typically excluded from coverage.

7. Out-of-Network Care: Visiting healthcare providers outside your plan’s network can lead to higher costs or a lack of coverage altogether.

Additionally, some plans may exclude fertility treatments, emerging technologies, or off-label drug use. Specific limitations may also be related to pre-existing conditions, dental and vision care, and long-term care. While most health insurance plans cover rehabilitative care, developmental services may not be included. For example, physical therapy after surgery might be covered, but speech therapy for a child with developmental delays could be excluded. Since exclusions can vary by insurance provider and plan type, comparing each option's details is crucial. 

What Are the Types of Health Insurance Plans?

Several health insurance plans are available in the CBC Marketplace, each offering different coverage options at various metal tiers (Bronze, Silver, Gold, and Platinum). Here’s a breakdown of the most common types: add level-funded (link it to the previous blog)

Health Maintenance Organization (HMO): 

Paragraph- HMOs are generally more affordable but limit coverage to in-network providers unless it's an emergency. You must choose a primary care doctor who will provide referrals to specialists. Additionally, you may have to live or work within a specific area to access services.

Exclusive Provider Organization (EPO): 

Similar to HMOs, EPOs only cover in-network care except in emergencies. However, you typically don’t need a referral to see in-network specialists. EPOs usually offer a larger network than HMOs but may come with higher premiums.

Point of Service (POS): 

POS plans enable access to in-network care but have a limited provider network. While you can seek out-of-network care, doing so will result in higher costs. Additionally, referrals to specialists must be obtained from your primary care doctor.

Preferred Provider Organization (PPO): 

PPO plans offer flexibility by allowing you to use both in-network and out-of-network providers, although out-of-network care will be more costly. You do not need referrals to see specialists, and selecting a primary care doctor is not mandatory.

Ways to Get Health Insurance

Here are some common ways to obtain the CBC Health Insurance Marketplace:

1. Short-Term Health Insurance: If you need low-cost coverage to bridge a temporary gap, short-term health insurance offers limited coverage at a lower price in most states. However, these plans often do not cover prescriptions, mental health services, or maternity care.

2. Employer-Sponsored Plans: These plans provide comprehensive coverage for employees and often include contributions from the employer, making them a cost-effective option for both parties.

3. Individual Plans: These plans are designed for individuals who prefer or need coverage outside employer options. They offer flexibility and can be customized to fit personal health needs. All of these options are available through the CBC Health Insurance Marketplace.

4. Small Group Business: For small groups, open enrollment can occur anytime based on when they purchased their health plan or when their renewal is due. However, it typically takes place once a year.

5. Special Enrollment Periods: If you experience qualifying life events such as marriage, the birth of a child, or loss of other coverage, you may be eligible for a Special Enrollment Period to enroll in a plan through the CBC Marketplace.

Final Thoughts: Empowering Your Small Business with the Right Health Insurance

Selecting the right health insurance for your small business is crucial for effectively managing costs and ensuring comprehensive coverage for your employees. By thoroughly understanding your healthcare needs, evaluating available plans, and comparing your options, you can make informed decisions that benefit your business and enhance your team's well-being. With various plans and coverage options available through the CBC Marketplace, you have the flexibility to find a plan that meets your specific requirements.

Custom Benefit Consultants, Inc. (CBC) is here to simplify the process and assist you in navigating your options. With expert support and customized solutions, we help you secure the best health insurance for your small business. Visit the CBC Health Insurance Marketplace to discover health insurance plans that fit your and your employees' needs. Ensure the coverage you deserve and foster a healthier, more productive workforce!

FAQs

1: When Is Open Enrollment for Health Insurance?

For small groups, open enrollment can occur anytime based on when they purchased their health plan or their renewal date. However, it typically takes place once per year. Employees can enroll in, change, or cancel their health insurance plans during this period. Businesses must stay informed about their specific enrollment windows to ensure that all employees have access to the necessary coverage.

2: What Contributes to the Cost of Health Insurance?

Health insurance reflects the investment in high-quality healthcare services. Medical care accounts for approximately 90% of health insurance spending, highlighting the value placed on comprehensive care. Factors such as administrative expenses and the investment in advanced medical technology contribute to these costs, ensuring patients receive the best possible treatment and support.

3: Where Can People Shop for Individual and Small Group Health Insurance?

A3: The CBC Health Insurance Marketplace is an excellent shopping option for individual and small-group health insurance. It provides a variety of competitive plans, making it easy for individuals and small businesses to compare options and select coverage that best fits their needs.

4: How Do I Choose Between Different Types of Health Insurance Plans?

Start by assessing your business’s and employees' healthcare needs. Consider factors such as premium costs, out-of-pocket expenses, and whether your employees prefer flexibility (like a PPO) or lower costs (like an HMO). Comparing the benefits and limitations of each plan type will help you make an informed decision.