Topic Area:  

  • Getting health insurance coverage

What trade-offs should I consider as I decide on a health plan?

Health insurance plans are complicated; and, that can make it difficult to decide which one to choose. To really understand what you're buying you need to step back and look at the whole plan as a package, adding up the pros and cons.

Look at the total cost

Looking only the monthly premium cost will not give you a good picture of what a health plan will cost you, unless you do not expect to use it. The premium is only part of what you will pay. Learn more

How much the plan requires you to pay for in deductibles, co-insurance, and co-payments is directly related to the premium. You can pay more every month in premiums and reduce what you have to pay when you need care, or you can get a lower premium by paying more when you use the plan.

No one knows for sure how much health care they will need in the coming year. But, you can think about what you are likely to need based on your past experience. Then, use the plan summary to estimate how much those services and prescriptions may cost in addition to the premium you will pay.

You can also use the Health Costs section of this site to compare costs at various providers/facilities and under different health plans. This can help you estimate how much you might pay for your care.

 

Provider networks

One of the common trade-offs in health plans is offering a higher level of benefits when you use in-network providers, or even (as with many HMO plans) requiring you to use in-network providers. Learn more

As you consider your options, take a look at the provider directories for the plans you're comparing and ask yourself:

  • How important is it to me to be able to see any provider I want?
  • Am I comfortable with a smaller network in exchange for a lower premium and/or higher benefits?
  • Is my current doctor in the network? Or, would I be willing to change for a lower premium and/or higher benefits?
  • Is my preferred hospital included in the network?
  • How big is the area covered by the network? Will I need network providers when I travel or for my children who live away from home?

Keep in mind that your provider may participate in more than one network. Also, individual providers, and even hospitals, can go in or out of a particular network at any time.

Level of plan oversight

Some plans manage care more closely than others. For example, the plan may require you to get a referral to see most types of specialists or get preauthorization before you receive certain types of care. Learn more

You may have to take additional steps for some types of care, but the idea is that the plan has a role in making sure members are receiving appropriate, effective care. These kinds of plan rules don't usually have a big impact on the level of premiums and benefits all by themselves but they are more present in some plans than others. Some people aren't bothered by these types of rules, but others would rather pay more for a plan with fewer restrictions.

4/9/2018