Health Plans or Health Insurance? What You Need to Know to Choose the Best Coverage

Health is the most precious asset we have, and the recent COVID-19 pandemic has shown us just how important it is to protect it. When we look for alternatives to ensure easier access to health care, we are almost always faced with two options: choose a health plan or health insurance.

With this article, we want to simplify your decision-making process. By the end of this article, you’ll learn the main differences between a health plan and health insurance, how each of these products works, and why you should choose an insurance broker when purchasing your insurance.

Health Insurance Plans: What Are They and How Do They Work?

The Health insurance plans are, in essence, discount cards, just like so many others we have in other areas of our lives. At hypermarkets, clothing stores, or bookstores… We’re given so many cards offering various discounts. The same can be said about health insurance plans. They offer discounts on access to a network of healthcare providers, with no limits on usage.

Although the annual premium is lower than that of health insurance, health plans have a number of limitations, one example being the exclusion of hospitalization. Furthermore, outside major urban centers, the network of participating providers tends to be insufficient, which makes it difficult to choose healthcare providers.

However, it should be noted that health insurance plans may be the only option in cases involving pre-existing conditions, insufficient funds, or very advanced age. Health insurance plans have no age limit for enrollment or continued coverage, and they are exempt from waiting periods.

Health Insurance: What Is It and How Does It Work?

Health insurance ensures easier, faster, and more convenient access to medical care and treatment, avoiding long wait times in the National Health Service (SNS).

By making it possible to schedule doctor’s visits, tests, surgeries, and treatments on a more regular basis, health insurance helps prevent certain health conditions and leads to a faster diagnosis, which can increase the chances of a cure.

Payment for health care services under health insurance plans is made through copayments within the network of participating providers, that is, through a predefined fixed amount. On the other hand, some plans also operate on a reimbursement basis, where the insured person pays the full amount of the expense and the insurance company reimburses a percentage of the amount paid by the insured person. There is also the option of a mixed payment plan, which combines the two previous payment types.

What are the advantages of health insurance compared to health plans?

Some people choose health insurance plans because of their low cost. But things aren't always what they seem…!

Health Insurance offers more comprehensive coverage; let's take a look:

• It offers round-the-clock service, 24 hours a day;
• Covers expenses related to medical visits (general and specialist);
• Covers the costs of treatment and additional tests;
• Includes expenses related to serious illnesses;
• It offers a wide range of coverage options tailored to your actual needs;
• It offers a choice among thousands of professionals who are part of the network of healthcare providers;
• It is valid for both outpatient and inpatient care;
• It allows for care to be provided at hospitals, doctors' offices, or at home;
• It offers flexibility and coverage tailored to your needs.

In addition, with health insurance, customers also benefit from the features of health plans; for example, some health insurance policies also include discount networks for certain medical specialties and wellness services, such as spas, gyms, and alternative medicine treatments.

How Do You Choose Between a Health Plan and Health Insurance?

The choice between a health plan and health insurance will always depend on your needs. If your main goal is to have access to discounted doctor’s visits, a health plan may be an option. However, If you want more comprehensive coverage that includes support in various situations, it’s best to purchase health insurance.

To help you make an informed choice, we suggest you follow these steps:

1. Assess your needs

There are a few questions that can help you assess what your actual needs are, with the aim of making the decision-making process easier. For example:

• In what situations do I spend—or might I spend—money on healthcare?

Here are some possible scenarios:

• appointments;
• hospitalization;
• childbirth;
• home doctor;
• outpatient clinic;
• home health nurse;
• online doctor;
• treatments and additional diagnostic tests, among other things.

The answer to this question will help you better understand your needs. This will make it easier to determine whether a health plan covers everything you need or whether health insurance is the best option.

2. Compare the quotes for the various insurance policies

Before making any decision, it’s a good idea to compare health insurance quotes from the top insurers on the market. The range of options is growing, and there are some very competitive products available, so it’s worth taking the time to explore the different options.

How can you run simulations quickly and securely?

It isn't always easy to compare the different health insurance plans available on the market. It's a time-consuming process that requires knowledge of the insurance market.

Imagine having to contact dozens of insurance companies to find the best deal that meets your needs. And then having to compare the different offers to find the best solution?

To make this process easier, there are insurance brokerage firms, such as EXS, that negotiate the most advantageous health insurance terms—tailored to your specific needs and financial situation—at no cost to you.

With over 25 years of experience in the insurance industry, she was recognized in 2020 as one of the TOP 10+ in the Financial Services and Insurance sector and also as one of the TOP 5% Best SMEs in Portugal.

To the Request a simulation, EXS will contact you to request additional information for an accurate simulation, which consists of:

• Compare the plans offered by the 26 best insurance companies in Portugal and find out which health insurance plan is best for you;
• Offer the most advantageous solution, with the most comprehensive coverage and at the fairest price.

EXS will always be available to answer any questions you may have.