For many, health-care open enrollment is around the corner. Should you switch or stay with your current? Insurance coverage can be complicated and at times difficult to understand. Below are some easy to follow rules when choosing the right health care plan for you and your family.

Consider your Premium Vs. Deductible and Copay

Many plans may seem like a smart financial choice until your faced with high deductibles and copays.

  • Family with children? A higher premium plan may actually be the smarter financial decision. For example a broken arm or ER visit due to a case of Strep throat can set you back a significant amount if you have high deductibles or copays.
  • Single healthy adult? A lower premium may be financially worth it, simply due to the fact that you are less likely to visit the doctor.

In short, when choosing a plan, consider both your budget, which will determine how much you can afford in monthly premiums, and your household’s likely health needs. This will enable you to consider your likely out-of-pocket costs.





Choosing the Best Plan

It is important to note that not all companies offer the same type of coverage. One must first research the type of plan that is right for you, then choose the right organization for your needs.

  • Health maintenance organization HMO: Premiums tend to be lower but offer more restrictions, on the basic level HMO’s match you with one primary care physician who is than responsible for all needed referrals.
    • Downside: You cannot choose any healthcare provider you wish.
    • Upside: you will be able to secure a more affordable monthly premium, since the HMO incurs a lower cost due to their agreement with these medical providers.
  • Exclusive Provider Organization-EPO: The EPO network is made-up of multiple providers, although no referral is needed, the patient must seek care from providers within a set network.
    • Downside: If EPO policyholders seek medical care outside the network, they must pay the doctor’s full rate on the spot, without any chance of reimbursement. Plus their rules tend to be restrictive and have less available doctors than HMO’s.
    • Upside: Due to only offering in-network providers EPOs are able to negotiate lower premiums and co-payments with doctors in their network. Policyholders are pretty much guaranteed to only visit doctors in network. EPOs may be a smart choice for individuals in a more rural area, where other types of medical care may not be readily available.
  • Preferred Provider organization PPO: PPO’s offer the most flexibility, offering coverage of in and out of network health care providers.
    • Downside: you will incur a larger monthly premium, than you would with a similar HMO or EPO plan.
    • Upside:  A PPO plan will cover expenses with any medical provider you see, that is the upside of a PPO plan.

Your specific needs will best determine the type plan needed. Important questions to ask yourself when choosing a plan include: 1) Will you feel limited if you have to stick to specific providers? 2) Can you afford the extra cost of a PPO? These simple questions will allow you to choose the best plan for you.

Know what plan is best for you? Peruse a number of plans here.  Can’t afford to pay much? Check out these affordable options. 

Major Milestones and Health Coverage

Changing jobs or expanding your family? These are prime times to change your current coverage or update existing plans. Here are three lifetime milestones that may require a change in plans.

  1. Starting a new job? Be prepared for benefit changes, gather information on ALL options prior to choosing a plan that is right for you.
  2. Getting married? A change in marital status can allow your spouse to add him/her to your plan or you to theirs. Combining insurance under one plan can possibly save you money, depending on your employers benefit package.
  3. Giving birth or adopting?  Ideally you will research and change your benefits prior to expanding your family. You may find it nesssercary to not only upgrade your plan, but possibly change it completely. It’s vital to pay attention to prenatal coverage, birth and delivery coverage, and copays for infant check-ups (they see the pediatrician A LOT).

*If you do have a change in status (marriage or children), make sure you request enrollment within 30 days of your marriage, adoption, or birth.

Ready to shop for health care polices? Here is an overview and comparison of different online health insurance sites.