How to Choose the Right Health Plan for Your Household: 10 Key Considerations

By Steve Dorfman

Let’s face it: health insurance is complicated. Really complicated.

The passage of the Affordable Care Act increased health insurance access for millions of Americans. But, if we’re being honest, it didn’t do much to simplify the actual process of procuring insurance.

Fortunately, American health insurance consumers have plenty of help in their quest for affordable plans that actually meet their needs.

They can help themselves, too.

Before you choose your health insurance plan, do a quick analysis of your household’s healthcare situation. These 10 key considerations, posed as simple questions, should help guide you as you work closer to your ultimate decision.

1. How Great Are Your Insurance Needs?

First, assess your insurance needs.

Gather as many bills and statements from medical providers as you can find. Ideally, you’ll want your record to stretch back at least two years, to get a rough average of your needs over time. Using those records, tally up the type and range of health services you required, and how much everything cost. This information will be crucial as you evaluate plan options for fit and cost.

2. Do You Have Insurance Options Through Your Employer?

Next, determine whether you have insurance options through your employer. Bear in mind that employer-sponsored insurance isn’t always the best choice, even when it’s readily available. Many employers offer plans with high premiums, high deductibles, limited provider networks, inadequate coverages, or other deficiencies.

 

“Many times, it’s possible to find better plans in state or national marketplaces, or through individual insurance providers.” — Steve Dorfman

 

If you do have access to employer-sponsored health insurance, you’ll want to apply the same tests as you would to plans available through other venues. Carefully review any plan documents or guides provided by your employer, and don’t be afraid to turn to an outside partner for help parsing them.

3. Do You Understand the Different Types of Health Plans Available in Your Area?

Next, evaluate the different types of health insurance plans and confirm which are available in your area.

This step trips up even the savviest healthcare consumers, largely because terms and definitions can be so opaque and confusing. For instance, you need to understand the difference between marketplace plan levels such as platinum, gold, silver, and bronze, and health insurance plan types such as preferred provider organizations (PPOs), health management organizations (HMOs), and the like.

You’ll need to refer to verified sources to ensure you’re getting accurate information about your choices and options. There’s a lot of disinformation out there.

4. Do You Understand Key Insurance Terms?

Ready for more word salad?

You won’t be a truly informed healthcare consumer until you have a basic understanding of key insurance terms. For instance, you’ve heard the term “deductible” before, but do you really know what it means?

No one likes to study, but remember: knowledge is power. In this case, it’s likely to save you money and produce better outcomes too.

5. How Much Can You Afford to Spend Out of Pocket Each Year?

Next, take a hard look at your household’s budget and task yourself a tough question: how much can you really afford to spend out of pocket each year?

Remember that out of pocket healthcare costs take several different forms: deductibles, coinsurance, copays, among others. That’s why it’s so important to understand key insurance and healthcare terms. If you’re confused about what exactly constitutes an out of pocket payment, or how to calculate your likely out of pocket costs, ask a licensed insurance agent.

6. How Much Can You Afford to Spend on Premiums Each Year?

Here’s another affordability question: how much you can reasonably spend on annual premiums.

For cash flow purposes, health insurers generally break up premiums into smaller monthly payments, making it easier to calculate their impact on your household budget. To determine whether you can afford a particular monthly premium payment, you’ll need to add up your projected premiums against other recurring expenses, such as mortgage or rent payments, car payments, and utility bills, as well as more variable expenses like groceries.

7. Do You Know Which Marketplace to Use?

Not all states operate their own health insurance marketplaces, and the federal health insurance market can be a bear to navigate. In many cases, your best option is to turn to a trusted partner capable of providing accurate rate quotes directly while educating you on the various features and benefits of each policy.

8. Is Your Network(s) Suitable? Will You Have Access to Your Preferred Providers?

One of the most important and confusing considerations for health insurance consumers is the network: that is, which providers actually participate in the policy’s rate scheme?

Choosing an out of network provider can be an immensely consequential decision. Make sure your preferred provider participates in the networks you’re considering.

9. Which Services and Coverages Do You Expect to Need?

Every healthcare consumer is different. That means you need to determine what plan is right for you, not anyone else.

As you evaluate health insurance plans, compare their features and benefits carefully against your own healthcare consumption patterns. Do they provide adequate, affordable coverage for the services you expect to need?

10. Are You Willing to Make Any Adjustments in Your Healthcare Consumption?

Last, but not least, determine whether you’re willing to make any adjustments to your healthcare consumption. This isn’t to say that you need to forgo essential services or benefits; you should never have to make such compromises. It’s merely a recognition that some non-essential changes, such as avoiding certain out of network providers, can dramatically reduce your out of pocket costs.

We’re Here to Help

Perhaps the most important decision you’ll make during your search for suitable health insurance is the choice to partner with a trusted insurance industry expert with the experience and expertise necessary to guide you to the plans that best fit your needs.

Simple Health is just such an expert. We’re committed to providing health insurance consumers with the widest possible range of choices and the most honest and direct assessment of their needs. With agents licensed to provide insurance in all 50 states, we’re capable of helping Americans from Florida to Alaska and everywhere in between. (And Hawaii.)

Steve Dorfman is the founder and current CEO of two Florida-based firms: Simple Health and Simple Insurance Leads.