8 Tips for Choosing Health Insurance

8 Tips for Choosing Health Insurance

Buy wisely.

It isn’t easy choosing health insurance, whether your employer offers it or you’re buying it yourself. Nearly half of all employers with 200 or more employees offer more than one plan, all with different premiums, copayments, benefits and deductibles. Use these tips to make sure you choose the right insurance for you and your family.

pill bottle with money in it
1. Consider Your Health
If you have one or more medical conditions that require ongoing care, such as diabetes or heart disease, you want a plan with a lower deductible and lower copayments. Same applies if you think you may be expecting a baby in the coming year. You’ll pay a higher premium, but your overall out-of-pocket costs may be lower.

2. Do the math.

People focus on the monthly premium, but you also need to look at the deductible. For instance, if you have a choice between a lower silver plan premium of $345 a month for a plan with a $5,500 deductible, and a higher gold plan premium at $465 a month with a $1,750 deductible, you’re better off with the second plan if you anticipate needing more than $1,500 in medical care. With the second plan, your total annual cost for the premium and deductible comes to $7,330, a $2,310 savings over the lower premium plan.

3. Look at out-of-pocket costs.

The deductible is just one out-of-pocket expense; you also have copayments and coinsurance. The three together are your maximum out-of-pocket costs. Under the Affordable Care Act, the maximum out-of-pocket limit is $7,150 for a single person and $14,300 for a family policy.

4. Review the provider list.

Most health plans today have “in-network” providers. If you see those doctors and visit those hospitals, you pay less out of pocket than if you go outside the network. So if you want to keep your own doctor and go to a certain hospital, make sure they’re on the provider list.

5. Read the list of benefits.

All individual and small business plans have to cover hospitalization, emergency services, lab tests, maternity and newborn care, mental health and substance abuse treatment, outpatient care (doctors and other services received outside the hospital), pediatric services (including dental and vision care), prescription drugs, preventive services, and rehabilitation services. The specifics of your employer’s available plans, however, may differ significantly​​, so be sure to read the plan’s Evidence of Coverage.

6. Look at the drug list.

All plans have a formulary, a list of medications they cover and the copayment for each. If you take prescription medicine, check the list to see if your drug is on it and how much refills will cost. If your medication isn’t on the formulary list, you may have to pay for it in full. Also, see if your plan offers a money-saving mail-in prescription option for prescriptions you take on a regular bases.

7. Ask the right questions.

Call the member services department of the health plan you’re considering or talk with someone in your human resources department and ask: Which doctors, hospitals, clinics or pharmacies participate in the plan? How much does it cost to go out of network? Am I covered during a travel emergency? What is the premium and out-of-pocket costs? What is the most I’ll have to pay out of my own pocket to cover expenses? Exactly what benefits are covered by the plan and what isn’t covered? How are disputes about a bill or service handled?

8. Check the plan’s quality.

Did you know you can check the quality of your plan with just a few clicks? The National Committee for Quality Assurance ranks health plans across the country based on their clinical performance, member satisfaction, and results from NCQA surveys.