What to consider when choosing a health insurance plan

There are many decisions in life that can be incredibly stressful. They require a lot of Googling, consulting with friends or family, and in the end we’re still left wondering, did I make the right choice? Choosing a health insurance plan is one of those stressful decisions. If you aren’t offered coverage by your employer, don’t have coverage through your spouse, or work for yourself, you may have to figure out what options are available on your own.

Fortunately, the Affordable Care Act has paved the way for those who historically have not had coverage — now providing a way to easily access care. Some quick notes about ACA plans:

● You are entitled to coverage regardless of any pre-existing conditions
● You are entitled to essential health benefits like mental health coverage, free preventive care, and prescription drugs
● Gives additional coverage options to more people, including young adults, women, and low-income individuals
● There are no longer limits on coverage

You can read more about ACA plans here.

So where do you begin? Over the last 5 years, HealthSherpa has helped over 1.4 million people enroll in coverage under the ACA. During this time, we’ve learned what questions people ask and what concerns come up when choosing a health insurance plan. Here are the three most important things to consider:

1. Your monthly budget

This is usually the first big decision you’ll need to make. A lot of people live paycheck to paycheck and can only afford to pay a certain amount per month for health coverage. Think about what you can put aside every month and then choose a plan within your budget.

Did you know 8 out of 10 people qualify to save on their monthly premium? Find out how much you can save here.

2. Your providers

If you already have a doctor or hospital you like, you’ll want to find out if they accept the plan you’re considering. If they do, they’re “in-network, which means lower costs for you. If they don’t, they’re “out-of-network”, which means you may end up paying quite a bit more. Before enrolling in a new plan, make sure to double check that your doctor or hospital accepts the plan.

You can also learn about the different types of networks, like HMOs and PPOs, here.  

3. Healthcare needs

Not everyone is able to predict what kind of coverage they’ll need throughout the year. To help identify what care you may need, think through these questions:

1. How often will I see my primary care doctor?
2. Do I have any specialists I want to see and how often?
3. Will I need any prescriptions?
4. How often will I go to the hospital?
5. Will I need any x-rays, labs, or other tests?

Answering these questions will help you determine how much you'll pay under any given plan for the year. If you're using HealthSherpa, we'll recommend the most affordable plan based on the services you need. Plus, you can look at the estimated costs for these services.

It's also important to know that every plan under the ACA offers free preventive care. This means you can access these services at no cost to you, from day one!