What’s the Best Health Insurance for Me?

See if your doctor or preferred hospital is included, if that matters to you.

You save money and might pay less out of pocket by staying in-network. Choose doctors or facilities within the health plan network. Using the network is easier if you’ve checked that the places you generally get care are part of the network. If not, are there network alternatives you can live with?

Even medical insurance plans of the same type with similar kinds of coverage can be different in the details. Match competing health care plans in terms of benefits and limitations that are important to you.

• Are prescriptions covered in the plan? Check to see if the drugs you use regularly are covered and for how much. Can you get a discount by ordering through the health plan’s mail order pharmacy?
• Is preventive medicine a part of your health care approach? Check plans for wellness benefits and coverage for routine doctor visits or testing.
• Mental health care, chiropractic visits, medical equipment – you know your own health care needs best. Check to see if what you might use is covered, and if so, under what conditions.

Brace yourself for this – even with medical insurance, you’re still going to have costs to pay out of your own pocket. Here’s your cheat sheet. Look for these five terms to get an idea what you’ll be paying during a year with a given health plan.

Premium – What you pay (usually monthly) to have medical insurance.

Deductible – What you must pay for expenses covered by your health plan before the insurance company will pay.

Copay – A set dollar amount you have to pay to receive certain services, like $30 for a doctor office visit.

Coinsurance – The percentage you pay of covered medical expenses after you’ve met your deductible, often 20% to 30%. That means every $20 to $30 out of $100 is yours to cover even after you meet your deductible.

Out-of-pocket maximum (or out-of-pocket limit) – The most you pay during the term of the health plan toward covered expenses.

Important Note
Generally speaking, premium payments and copays don’t count toward your deductible.

Hospital and doctor fixed indemnity plans¹ pay a set amount of money after you receive specific covered medical services. Regardless of other insurance coverage, these plans pay cash once a covered expense is submitted for some of the most common medical situations you’re likely to face: surgeries, trips to urgent care or the ER, a visit to the doctor for the cold you can’t shake.

As a companion to your medical insurance, a hospital and doctor plan can help you deal with costs like deductibles and copays that your main insurance doesn’t cover.

No matter how good it is, no medical insurance plan is going to cover everything. You can fill in the areas you need with additional plans.

• Dental insurance for basic dental services.
• Vision insurance to help the costs of standard eye exams, glasses and contacts
• Critical Illness insurance or Accident insurance to help pay unexpected large medical expenses

With supplemental health plans like these and others, you have more freedom to build up coverage in areas where you feel the need.

Certainly, these five steps aren’t the only areas to consider when deciding where to buy health insurance. But they are a simple way to help you focus in on your needs and eliminate health care plans that aren’t worth your time or might not be the right fit.