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6 Things to Consider in Choosing the Right Health Plan

By Lisa Zamosky

woman looking at computer

Today marks the start of open enrollment under the Affordable Care Act, and the launch of new online health insurance Marketplaces.

If you are currently uninsured, buy health insurance on your own, or run a small company and would like to provide your workers with coverage, this is the time to take a look at the new health insurance options available. Open enrollment will run from October 1 through the end of March, 2014.

As you head to the Marketplace in your state, here are 6 things to be aware of when deciding which health plan is the best option for you and your family.

  1. Know the levels: There are four different types of health plans that can be sold through the Marketplaces — bronze, silver, gold, and platinum. All of them must cover what are called Essential Health Benefits, which include services that fall within 10 different categories.
    The primary difference among the “metal” levels will be how much they pay, on average, toward the cost of services the health plan covers. Generally, lower cost health plans will require you to pay more each time you go for care.  The more you pay for your plan, the more it typically covers in out-of-pocket costs.


  3. Do the math: If you rarely go to the doctor, it may be less expensive for you to select a plan with a lower monthly premium even if it requires you to pay more each time you go for care. If, on the other hand, a chronic health condition has you at the doctor’s office several times each month, you may find you’ll spend less money in the long run by paying a higher monthly premium, but less at each visit.

  5. Know all costs: Premium – the bill you pay each month for your health plan –  is only one marker of how much you’ll spend on your coverage. Each health plan will have a different combination of deductibles, co-pays, and co-insurance, and these costs can quickly add up. You need to take all of your potential costs – premium, deductibles, co-pays and co-insurance — into account when deciding which plan will meet both your medical and financial needs.

  7. Look for service limits: Although insurers can no longer apply lifetime and annual limits on care, limits can be placed on the number of visits for certain types of services, such as physical therapy. If you have a particular health need, read those details carefully to make sure you’re covered.

  9. Watch the network: One strategy insurers are using to keep costs down is by limiting the number of doctors and hospitals they include in their provider networks. If you have insurance now, don’t assume new plans sold by the same company will give you access to the same list of healthcare providers.  It’s important to examine the provider panel carefully before selecting a health plan, especially if continuing to see your doctor or visit a particular health system is important to you.

  11. Pay attention to drug formularies: If you take a lot of medications you’ll also need to closely evaluate each health plan’s list of covered drugs to make sure the medications you need are on the list. Also check to see if your plan has a list of preferred pharmacies where you’ll pay less for your medications than if you go to one considered out of network.

Are you planning on buying health insurance through your state’s Marketplace? Share your thoughts and/or experiences in the comments section below.




The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Second Opinion are... Expand


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