Choosing a Health Insurance Plan: A Step By Step Guide

If this is your first time buying health insurance for yourself and your loved ones, then it won’t be long before you figure out that the health insurance landscape can be quite difficult to navigate.

But we can help make things easier for you with this short checklist.

First, you need to choose a plan.

If you’re looking for individual and family plans, just go to the government insurance exchange or your state’s health insurance marketplace. It’s also possible to buy coverage directly from an insurance company but doing so will automatically make you ineligible for any government subsidies.Image result for Choosing a Health Insurance Plan: A Step By Step Guide

Next, compare different types of health insurance plans.

The most common ones are PPOs, HMOs, EPOs, and POS plans. You’ll be able to figure out your out-of-pocket costs and which doctors you can go to based on the kind of plan you get.

On a related note, make sure to check the summary of benefits for each plan you’re eyeing. Marketplaces often provide a link to the benefits summary as well as a provider directory where you can view the clinics and doctors that participate in the insurance plan’s network.

Compare the plans’ networks.

When you go to an in-network doctor, you will be paying less because your insurance company contracts lower rates with providers who participate in their network. Without contracted rates, you will end up paying a lot of money on doctor’s visits. If you already have a preferred doctor and you want to continue seeing them, then check if they are in the provider directory of the plan you want to get. If not, you also have the option to ask your doctor to participate in that health plan’s network.

Know the out-of-pocket costs.

You need to have an idea of how costs are shared. The summary of benefits of any health insurance plan should clearly explain how much you (the insured) will pay out of pocket for certain services.

Generally speaking, a plan that has higher monthly premiums will have lower out-of-pocket expenses. So you may want to go this route if:

  • You see your doctor regularly.
  • You require emergency care frequently.
  • You take expensive medication to manage your condition.
  • You have an upcoming surgery.
  • You have been diagnosed with a chronic illness.

On the other hand, it may be a good idea to get a plan with lower premiums but higher out-of-pocket costs if:

  • You are in excellent health and rarely see a doctor.
  • You are unable to afford high monthly insurance premiums.

Lastly, don’t forget to compare the benefits. Right now, all Obamacare plans have ten essential benefits. But there may be other benefits that are available in some plans but are excluded in others. Make sure to check the summary of benefits before making a decision. Remember that your health and well-being depend largely on the kind of coverage you have. So choose wisely.


Stanley Kessinger