Finding the Best Health Insurance Plan: Top 5 Things to Consider


By Stephanie Dube Dwilson November 01, 2016 Posted in: Family Health , Article

Finding the best health insurance plan for you and your family doesn't have to be difficult, thanks to the wealth of information available online. You may be feeling nervous about choosing a plan during open enrollment, but you actually have everything you need right at your fingertips.

Keep these questions and considerations in mind when looking for a plan that's an ideal fit.

1. What Exactly Does the Health Insurance Plan Cover?

Health insurance plans are easy to understand -- if you know what to look for. Whether the plan is categorized as Bronze, Silver, Gold, or Platinum, it will still cover essential benefits if it's offered to individuals or by a small business. These benefits include emergency services, maternity, hospitalization, mental health, prescriptions, labs, preventive care, and more. Large employers operate under slightly different requirements, but most offer plans that cover essential benefits, too.

This means the quality and type of care you receive will be the same -- only the costs will be different. The main exception is an older plan that is "grandfathered in." If you renew an older health plan that you had before the Affordable Care Act was enacted, it might not offer the same coverage that newer plans do. You can ask each insurance company for a summary of benefits and coverage to see exactly what the plan covers.

2. How Much Will the Plan Really Cost You?

A big difference among plans is how much they cost. Consider these categories:

  • Monthly premiums. This is how much you'll pay each month for your plan. These numbers can be a little misleading because lower premiums may mean higher costs in other categories.
  • Deductibles. This is how much you must spend in a year before your insurance contributes to your medical costs. Some plans offer some coverage before your deductible is met, such as a certain number of doctor's visits and prescription copays.
  • Coinsurance. This is the percentage of your medical bills that you'll have to pay after you meet your deductible.
  • Out-of-pocket maximums. This is the maximum amount you can spend in a year. After you reach this number, your insurance company will cover 100 percent of your medical expenses.

It's important to review the costs in all these categories. A low premium might come with a high deductible or coinsurance, thus costing more in the long run if you visit the doctor often.

3. Do You Go to the Doctor Frequently?

Before choosing a plan, consider just how often you go to the doctor in a given year. If you don't have regular prescriptions and you typically don't visit a physician often, then a plan with a higher deductible and a lower premium might be a good choice. If you visit the doctor frequently or have conditions that require a specialist's help, you'll likely want to pay a higher premium so more of your medical expenses are covered.

4. Is Your Doctor or Hospital in the Plan's Network?

Another important factor is whether your doctor is in your health plan's network. A health care network includes the physicians, hospitals, labs, and pharmacies that a plan covers. Out-of-network doctors might cost more or not be covered at all. Some insurance companies have a directory online that lists the providers in their network. You can also call your doctor directly and ask if they're in the insurance's network.

5. Chat With an Insurance Broker for More Help

If you're still uncertain about which plan is right for you, consider talking to an insurance expert or broker. This can be especially helpful if you're self-employed or buying insurance outside of your employer's network. A broker will be able to answer your questions about specific health conditions or plans.

Finding the best health insurance plan for your and your family's needs doesn't have to be an overwhelming task. Just make sure you do your research early -- that way, you'll have plenty of time to decide before the open enrollment window closes.

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