5 Things to Consider When Choosing a Health Insurance Plan

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Health care can get expensive, especially if you run into an unexpected medical emergency. Even with health insurance, the costs can be difficult to bear. Without insurance, the costs are practically impossible to manage if you end up in the hospital, or need other emergency care.

Choosing your health insurance plan requires that you consider a combination of affordability and adequate coverage. As you look into your options, here are 5 things to keep in mind.


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1. Coverage Offered

Find out what coverage is offered. This is about more than just making sure that your chiropractic visits will be covered, and that you have maternity coverage. Some of the things to look into include:

  • Preventative care: The PPACA requires that all health plans cover “preventative care” without charing a co-pay or making other charges. However, you need to find out what’s included in that. Your health insurance company can determine how many visits are needed for preventative care, as well as what items are included.
  • Pre-existing conditions: Find out what constitutes “pre-existing”, as well as what might not be covered.
  • Mental health services: Not all plans cover mental health services, so you need to take a close look at this item.
  • Alternative treatments: Some alternative/complementary treatments, such as acupuncture, massage, homeopathy, and other “non-traditional” therapies might not be covered by your insurance plan.

Think about what coverage you will likely need in the next year or so, and make sure that your plan has it.

2. Provider Network

Make sure you know which care providers are in the network before you sign on. When we chose our insurance provider, my husband and I wanted a provider network that was present in our own town, but also included care providers in my parents’ town and my husband’s parents’ town. We looked to make sure that the provider network was adequate, since we travel a decent amount.

Look into the provider network where you live, as well as in the areas where you normally visit. Compare the cost of in-network care to out-of-network care, and you’ll see that it makes a big difference.

3. Out of Pocket Costs

Look into what you will be expected to pay when it comes to your health plan. This includes your monthly premium as well as your deductible.

Consider whether or not it makes sense for you to go with a high-deductible health care plan. These plans require you to pay more upfront. While you’ll still get your preventative care visit for free, you will likely have to pay the entire cost of other visits out of pocket until you reach your deductible. The main advantage is that you pay a lower monthly premium.

My family has a high deductible plan. However, since we rarely need health care services, paying out of pocket isn’t a problem. The monthly premium is low enough that, even paying out of pocket, our yearly health care costs are below what they were when we had a lower deductible and a much higher premium.

Evaluate your own needs, and run the numbers. Then look at whether or not you can handle the out of pocket costs. I find that having an adequate emergency fund to meet the deductible, along with a HSA, is a great help. Make sure you understand your out of pocket costs, and your ability to meet them, before you commit to a plan.

4. Are there Plan Perks?

Some health insurance plans have perks like wellness incentives. At one time, and employer of mine had plans that provided discount memberships to qualified gyms or exercise programs. I used mine to get a discounted membership to Curves.

If you have an employer, find out if there are perks associated with healthy behaviors, or if there is a HSA or FSA connected to the plan (your employer might even contribute). You might find that there are some great perks that can offset some of the other costs.

5. What’s the Medication Policy?

Finally, find out about pharmaceutical coverage. Find out about whether or not certain generics are covered, and whether or not you will have to pay the entire cost for name brand medications. I have a name brand medication that I pay the entire cost for. However, the low monthly premium makes it worth it. Even paying full price for this medication, I still save over what I paid a few years ago, since my insurance company never covered this medication.

Make sure you understand what’s covered, especially if you have a specific medication you want to use.

With careful consideration, you can choose a plan that’s right for you, and that you are more likely to be able to afford.

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11 years ago

Good advice, but in the run up to 2014 there will be a tremendous crush of infomation about health insurance plans. Whatever else the PPACA has done, it has made it MUCH more complicated to secure insurance and to see a doctor. There are other non-insurance alternatives that exempt individuals from the individual insurance mandate (in PPACA), namely, religious medical sharing organizations. All of these share medical bills among members (as opposed to risk as with insurance), and have been in existence for more than 15 years. They are far cheaper than any insurance (save that enjoyed by Congress and… Read more »

11 years ago

Thanks for the good content on health plans. I have a high deductible plan. The premiums are getting so high that within two to three years the monthly amount could equal my mortgage. This is not sustainable for me and I’m wondering what the heck will happen then.

11 years ago

It is also my problem to sustain and keep my health insurance policy since the monthly premium is getting higher. I wonder how am i going lower my health insurance rate since it is i know deep inside that this is never going to stop.

5 Things to Consider When Choosing a Health Insurance Plan

by Miranda Marquit time to read: 3 min
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