How to Choose a Health Insurance Plan

December 19, 2016

Are you confused about choosing a health insurance plan? You’re not alone.


Many consumers quiver at the thought of having to dive into health insurance jargon and decipher premiums to make an informed decision.

Before you take out your wallet, learn the best steps to follow when selecting an insurance plan.

1. Compare Plans

The Marketplace will have various types of plans from which to choose. The most common ones are PPO, HMO, POS or EPO. To break down what each plan means for you, use this summary:

  • Health Maintenance Organization (HMO). You must stay in-network and get a referral for specialists or procedures, but this plan has lower out-of-pocket costs and features a primary doctor who will coordinate your healthcare.
  • Preferred Provider Organization (PPO). You can go outside of the network, but in-network will generally cost less. You don’t need a referral for procedures or specialist visits. This plan is ideal if you want more options for providers.
  • Exclusive Provider Organization (EPO). You must stay in-network, except if you have an emergency. You won’t need a referral for procedures or specialist and these plans usually have lower out-of-pocket costs.
  • Point of Service Plan (POS). You won’t have to stay in-network to be covered; however, you’ll pay less by doing so. To go outside of network, to see a specialist, or have a procedure done, however, you’ll need a referral. This type of plan is ideal if you’re seeking more provider options, as well as a primary doctor who will coordinate your healthcare.

2. Compare Networks

While some plans will let you go out of network to see a physician, you’ll usually pay more. So if you’d like to keep seeing your doctor, be sure to choose a plan in which your doctor is in-network. If you are open to seeing a new primary care physician, you’ll have more options in terms of plans.

For instance, if you live in a rural community, you’ll want to be able to see your local doctor, rather than travel a long distance to visit a physician. However, if you need to have a procedure done, you’ll want a plan with a fairly large network.

3. Compare Plans

Perhaps the most important factor when comparing plans is the out-of-pocket costs. This is your “share” of the expenses that you’ll cover. It can be difficult to compare costs because these expenses may be shared through a deductible, copayment or coinsurance. As a result, comparing plans can be a challenge.

Keep in mind that lower-premium plans usually have higher out-of-pocket costs, and higher-premium plans will have lower out-of-pocket costs.

Generally speaking, you should go with a plan that has higher premiums but will pay a larger portion of your medical bills, if:

  • You visit the doctor often.
  • You go to the emergency room frequently.
  • You take brand-name medications or costly pills.
  • You are going to have a baby, you have a newborn or small children.
  • You are planning on having surgery soon.
  • You have a chronic condition like cancer or diabetes.

On the other hand, your best choice of health insurance plans will be one with lower premiums and higher out-of-pocket costs if:

  • You aren’t able to pay for a plan with high monthly premiums  –  and as a result, get lower out-of-pocket costs.
  • You don’t see the doctor very often.
  • You’re generally healthy.

4. Compare Benefits

Don’t forget to compare additional services like medication costs, and other benefits like whether specific drugs you need to take for a chronic condition or services like maternity are covered, how medical services incurred while traveling abroad are handled, and so forth.

You can do all of these steps with an expert guiding you along the way. In fact, it’s probably best that you get professional assistance so you don’t miss out on savings or choose a plan that doesn’t meet your needs.

InsureOne Benefits is happy to help. Give us a call today to start exploring your options!