Some people don’t really have a selection of health plans. They might need to take Medicaid or a single plan offered at work. Others must make a choice: They’re looking at many different plans offered at work, or on the Health Insurance Marketplace, or by private insurance companies. Maybe Medicare is another option. The bottom line: If you’re choosing between health plans, certain tips and strategies can help you pinpoint the best option for you.
The price of your plan starts with your premium, also known as the monthly cost of your policy. But it will also include additional charges, such as your:
A fixed amount that you are responsible for paying per year before your insurance provider will begin to cover part of the overall cost. Some plans have higher deductibles than others. See more about deductibles
A set amount (flat fee) that you pay for a health care service. It is usually paid when you receive the service. The amount can vary.
Coinsurance is different than a copay: It’s your share of the cost of a health care service. Coinsurance is usually a percentage (for example, 20% of the cost of a prescription medicine).
Open enrollment is a period of time set aside for people to enroll in, or switch, their health insurance plan. Be aware of your open enrollment dates each year. Open enrollment dates are different for everyone, which is why it’s important to know when your dates are. Check with your insurance company for open enrollment dates for your plan. Switching plans outside of this time is usually only possible if you have a life change such as marriage or the birth of a child, or you lose your existing insurance (for example, because of a job loss).
If you want to renew your existing plan, keep in mind that many health insurance plans change their costs, coverage, and benefits each year. Check to make sure your doctors, prescriptions, and other benefits are still covered under your plan, and see if any costs have changed.
If you’re shopping for a new plan, look for one that meets your unique needs, such as:
Doctors, hospitals, and other preferred health care providers
Medical supplies such as diabetes
Hearing, vision, and dental benefits
Home health care
While affordability is important, it’s also essential to make sure your plan doesn’t leave out the coverage you need. Keep in mind that the plan with the lowest monthly premium may not turn out to be the least expensive in the long run.
Some plans may have a high deductible and low premium. This means that although your monthly costs may be low, the amount you spend on your health care may be much higher, especially in the beginning of the year. This is because you are responsible for 100% of your health care costs until you meet your deductible. This type of plan may be good if you do not need a lot of medical care.
Other plans may have a high premium and low or no deductible. These types of plans tend to have more predictable costs, especially if you have a chronic illness like diabetes.
You can see which insurance plans might cover your medications by looking at their formularies. A formulary is a list of prescription medicines covered by a health insurance plan.
Formularies differ from plan to plan, and an individual plan’s formulary can change every year. Medications on a formulary are usually grouped into tiers.
A preventive drug list is a list of medicines your health insurance plan must cover even if you have not met your deductible. This means you will only need to pay a copay or coinsurance for your medicines. A plan can add medicines for chronic diseases, like insulin, to its preventive drug list.
Some of your medicines may not be covered by your health insurance plan. If you and your doctor agree it is a medicine you need, your health care team can try to get it covered. Sometimes, it may take several tries and follow-up letters from your doctor for your health insurance plan to approve your medicine.