Step-by-Step Guide to Choosing a Health Insurance Plan

The health insurance landscape can be tricky to navigate. Here’s a start-to-finish guide to choosing the best plan for you and your family, whether it’s through the federal marketplace or an employer.

Step 1: Find your marketplace

Most people get health insurance through an employer. If you’re one of them, you won’t need to use the government insurance exchanges or marketplaces. Essentially, your work is your marketplace.

If your employer offers health insurance and you still wish to search for an alternative plan in the exchanges, you can. But plans in the marketplace are likely to cost a lot more. Most employers that provide insurance pay a portion of workers’ premiums, so they’ll likely offer the least expensive option.

Step 2: Compare types of health insurance plans

While comparing plans, look for a summary of benefits. Online marketplaces usually provide a link to the summary and show the cost near the plan’s title. A provider directory, which lists the doctors and clinics that participate in the plan’s network, should also be available. If you’re going through an employer, ask your workplace benefits administrator for the summary of benefits.

Step 3: Compare health plan networks

Costs are lower when you go to an in-network doctor because insurance companies contract lower rates with in-network providers. When you go out of network, those doctors don’t have contracted rates, which costs your insurance company, and you, more.
If you have preferred doctors and want to keep seeing them, make sure they’re in the provider directories for the plan you’re considering. You can also directly ask your doctors if they take a particular health plan.
If you don’t have a preferred doctor, you’ll probably want a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community since you’ll be more likely to find a local doctor who takes your plan.

Step 4: Compare out-of-pocket costs

Nearly as important as network size is how costs are shared. Any plan’s summary of benefits should clearly lay out how much you’ll have to pay out of pocket for services. The federal marketplace website offers snapshots of these costs for comparison, as do many state marketplaces.
This is where it’s useful to know a few health insurance vocabulary words. As the consumer, your portion of costs consists of the deductible, copayments, and coinsurance. The total you spend out of pocket in a year is limited, and that maximum is also listed in your plan information. In general, the lower your premium, the higher your out-of-pocket costs.

Step 5: Compare benefits

By now, you likely have your options narrowed down to just a few. To further winnow down, go back to that summary of benefits to see which plans cover a wider scope of services. Some may have better coverage for things like physical therapy or mental health care, while others might have better emergency coverage.

If you skip this quick but important step, you could miss out on a plan that’s much better tailored to you and your family.