Individual and Family
What Is the Best Health Insurance Plan for Me?
Published on August 19, 2014
Updated June 7, 2018
Choosing between different health insurance plans isn’t always easy. There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. To help you answer this question, here are a few things to consider:
1) Are you going to need long-term coverage or just something for the short-term?
If you’re between jobs for a temporary period, you may want to look into our short-term coverage options which can provide coverage from 30 days up to 12 months. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered by an individual and family health insurance plan that provides longer term coverage.
2) Are you looking for basic coverage or more comprehensive coverage?
Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness (these plans don’t qualify as minimum essential coverage and may not provide all essential benefits from a major medical plan).
Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits, and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage and may be appropriate for people who intend to use their insurance on a regular basis.
The Patient Protection and Affordable Care Act (PPACA) requires that major health insurance plans must provide coverage for certain preventive benefits, immunizations, and screenings* without cost-sharing requirements for plan/policy years beginning on or after September 23, 2010. This rule does not apply to grandfathered plans.
*As recommended by the U.S. Preventive Services Task Force, the CDC, and the Health Resource and Services Administration (HRSA).
3) Would you rather pay for your services before you use them or when you use them?
Typically, the higher the monthly premium that you pay, the less you will pay per doctor’s visit in copayments and deductibles. If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher copayment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.
4) How important to you is easy access to specialists?
Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.
5) Do you have a specific doctor or hospital that you would like to visit for health care?
Some insurance plans have provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan uses. You’ll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks used by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.
6) What is the most you could pay out in case of a serious illness or injury?
Health insurance plans typically place limits on how much a member is required to pay out of pocket per year for his or her health care. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your health care, the health insurance company typically covers all other costs for the remainder of the benefit year. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.
*Essential health benefits will be determined by the Secretary of Health and Human Services.