How to Choose a Health Insurance Plan
How do I choose a health insurance plan?
Start with what you already know about your own care: the doctors you want to keep, the prescriptions you take, and how often you expect to use healthcare. Then compare plans on network, deductible, out-of-pocket maximum and drug coverage. Compare premium last, in the context of everything else.
Most people begin with the monthly premium because it is the easiest number to compare. It is also the number least likely to tell you what a plan will actually cost you over a year.
A plan's real cost is the premium plus whatever you pay when you use care. That second half depends on the deductible, the copays and coinsurance, whether your providers are in network, and how your prescriptions are covered.
Working in the other order — care first, cost structure second, premium last — usually surfaces the tradeoff that actually matters to your household.
What to compare
- Provider network and whether your doctors participate
- Deductible and what applies before it
- Out-of-pocket maximum
- Prescription coverage and drug tiers
- Plan structure — PPO, HMO or otherwise
- Monthly premium, considered last
Important exceptions
- If you rarely use care and have savings available for an unexpected year, weighting premium more heavily can be reasonable.
- If you have regular appointments, ongoing prescriptions or specialists you rely on, network and drug coverage often outweigh a lower premium.
- Financial help through the Marketplace, where available, can change the comparison significantly.
Dave's perspective
“I ask people the same first question every time: who are your doctors and do you want to keep them? That answer eliminates more plans than any budget conversation.”
Dave Gagleard · Dave Knows Health
Related information
Plan availability, eligibility, benefits, exclusions, underwriting requirements, enrollment periods and coverage vary by carrier, product and state.