How Do I Choose a Health Insurance Plan?

Choosing your health insurance plan can be overwhelming and confusing. People often over-analyze health insurance plans in fear that they are going to be left out in the cold if they choose the wrong one. There is no right or wrong answer unfortunately, and you can’t necessarily predict what health issues may arise in the upcoming year.

The reality is that most plans offer the same benefits like prescription drugs, surgeries, other procedures, etc. This is one of the things the Affordable Care Act (commonly known as Obamacare) has concentrated on. It has tried to streamline the inner workings of the benefits to the consumer.

So whichever carrier you have, be it Aetna or Empire, whether it is a Bronze, Silver, Gold, or Platinum plan, you are basically going to get the same level of care. Bronze doesn’t necessarily mean “bad” and Platinum doesn’t necessarily mean “good”. It is really based on your needs and how you want to spend your money.

There are pros and cons to every plan. One carrier and one plan may work for you, while a completely different carrier and plan may work better for your spouse. Further, one plan that worked well for you one year may not work for you another year depending on your overall health.

Choosing a plan can be down into two variables:

  1. Does the Network of Doctors work for you/your family? Not all hospitals and doctors are in every network. If it is important for you to continue to see the primary care doctor that you’ve been seeing for years, you would select the plan with your doctor’s network. Generally speaking the bigger the network, the more the cost in premium. A bigger network means more options. That doesn’t mean if you have a smaller network the doctors in it are worse or you won’t be able to find care, you just have less doctors and hospitals to choose from.

 

  1. Do you want to pay more in premium or more at the doctor? Depending on how much risk you want to absorb will have a direct effect on your premium. You don’t want to overpay the insurance company for something you might or might not use. So if you don’t go to the doctor very often, you may want to consider a plan with a lower premium. You would wind up paying more at the doctor, but less in premiums throughout the year. However, like the network decision, it is up to what works for you in your unique situation.

 

Once you have these two questions figured out, it should be easier to pick a plan that suits your current needs. The bottom line is that it is insurance, not an investment. Sometimes you will win, sometimes you will lose. In most cases there is no way to know what the best plan was for you until the year is over. If a health issue arises, you may want to choose a different plan the following year.

Besides knowing which plan to pick, understanding some health insurance lingo is helpful. What’s the different between a co-pay and co-insurance? The chart below breaks down some terminology that will help you understand your health insurance plan better.

 

Health insurance terminology cheat sheet

 

Picking a health insurance plan can be intimidating, but it doesn’t have to be difficult. Understanding your current health needs, which doctors you want to be able to see and how/where you want to spend your money are important and will help you choose a plan that’s right for you.

What do our clients have to say?

They made it such an easy decision.

Christopher Hayward
Sag Harbor, NY

You get to the point where the relationship is more important then the coverage.

Tim Blenk
President, Tim Blenk Tree Care Southampton, NY

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