Let’s face it: choosing a health insurance plan isn’t as simple as picking the plan with the lowest monthly rate. You may do this with car insurance or homeowners insurance – taking a gamble by choosing the cheapest plan and hoping you never have to use it. But health coverage is different. You should be using it, even if you’re healthy.
So how do you choose a plan that gives you the right amount of coverage without breaking the bank? It will take a little work, but here are some questions to help you get there.
1. What’s the total cost of health coverage?
Math may not have been your favorite subject in school, but it’s important when it comes to shopping. It helps you compare prices, figure out discounts, and, most importantly, understand the total cost of health coverage.
Total cost of health coverage = Cost to buy it + Cost to use it
What does this mean?
The cost to buy health insurance is your monthly premium, what buys your membership into a plan. It gives you access to lower rates on your health care. But you also have to consider the cost to use your plan, aka your out-of-pocket costs, when you actually need health care.
There are three types of out-of-pocket expenses that factor into the cost of health coverage. These vary according to the health benefits covered under your plan, but you’ll find that preventive care is 100 percent covered. This means you won’t have to pay any money out of pocket for covered preventive services, like your yearly check-up, flu shot, gynecological exams, or birth control.
- Copay – Short for copayment, copays are simply a flat fee you pay for medical care, like $30 to see your primary care doctor, or $50 to see a specialist, like your allergist.
- Deductible – A deductible is the amount you pay each year before your health plan starts paying for covered health services. For example, if your plan has a $1,000 deductible, you pay the first $1,000 of the costs before your health insurance plan starts paying a portion, or all, of your health care costs. When choosing a plan, find out if your plan has a separate deductible for prescription drugs, or if they count toward your medical deductible.
- Coinsurance – Once you reach your deductible, your health insurance plan covers a portion or all of the health care costs covered under your plan. For example, your health insurance may cover 80 percent of the costs, which means you’re responsible for the remaining 20 percent. But you won’t pay coinsurance forever — once you hit your out-of-pocket maximum for the plan year, you are covered 100 percent by your health plan.
Is financial help available?
Yes! As part of the Affordable Care Act, the government offers financial help to help offset the cost of health coverage. You may be able to get lower monthly premiums, lower out-of-pocket costs, or both. Don’t write this off if you think you make too much money. You’d be surprised at how many people qualify. Check out our subsidy calculator to see if you qualify for financial help.
2. Would you rather pay less now, or pay less later?
Why does it matter? Because it’s a balancing act that can help you save on your health insurance.
Here’s the difference between the cost to buy and the cost to use health insurance: You will always have to pay your monthly premium, but you will only pay your out-of-pocket costs (copays, deductibles, coinsurance) when you use your health insurance.
And that’s why you want to aim for the “Goldilocks level of coverage” — not too much, not too little, but just right for you.
- Too much coverage – If you’re healthy and don’t frequently see doctors or need medications, you may not need a plan with the highest monthly premiums and the lowest out-of-pocket costs. In fact, you may be able to reduce your total cost of health coverage by spending less each month in exchange for higher costs when you need care. For example, if you’re spending $40 less a month on your premium, that means you have $480 that you could put toward your out-of-pocket expenses, or even better, back into your wallet if you didn’t need that much care.
- Too little coverage – If you see doctors often, need multiple medications, or have family members who do, it may make sense for you to pay a little more upfront to have lower out-of-pocket costs when you’re making those frequent visits or filling your prescriptions. If you choose a plan with too low of a monthly premium, it’s possible you could spend much more out-of-pocket than you would have with a plan that offers more coverage.
- Just right coverage – Yes, it is possible to find the Goldilocks level of coverage, and the best way to do it is to consider your health past, present, and future. Here are some questions to ask yourself:
- Do you have chronic conditions or old injuries that require care?
- Do you take any prescription drugs regularly?
- How about the near future — are you planning to expand your family or do you need to have surgery?
- How much are you comfortable paying each month for coverage?
- Do you have enough “just-in-case” coverage for unexpected injuries or illnesses?
3. Are there doctors or hospitals you prefer to visit?
One of the advantages to having health insurance is that you get access to care at special rates. Your health insurer negotiates lower rates with the doctors and hospitals in its network so that when you pay your deductible or coinsurance, it’s less than what you’d pay without health insurance.
If you have trusted doctors or hospitals you prefer to visit, make sure they are considered “in-network,” meaning in your health insurance plan’s network. The same goes for pharmacies. If it makes a difference to you where you fill your prescriptions, make sure your local pharmacy is part of the pharmacy network.
If you don’t have doctors or hospitals you prefer, or don’t mind switching, then you may want to look for a health insurance plan with a tiered network. Our tiered network plans group the full network into three tiers based on cost, and in some cases, quality measures. You save the most when you visit Tier 1 providers, but you always have the choice to visit Tier 2 or Tier 3 providers if you wish.
4. Do you need other types of health coverage, like dental and vision insurance?
When you buy an individual or family health plans from Independence Blue Cross, your kids age 19 and younger are covered for dental and vision care too. But adults need dental and vision coverage too!
If you need coverage for yourself or another adult on your plan, you can purchase one, or both, of those plans separately. And fortunately, they are much easier to choose. Simply pick a plan based on whether you need basic coverage or more comprehensive coverage. We have a variety of affordable adult dental plans and adult vision plans for you to choose from.
5. Would you like more help choosing the right health insurance plan for you?
We covered a lot, I know! But the good news is that you don’t have to make the decision on your own. We have experts and decision-making tools to help you figure out the total cost of health coverage and find the right plan for you. Pick the type of support that works best for you:
- Online. Whether you want to compare plans side by side or find out if you may qualify for financial help, we have the tools to help. Visit ibx4you.com to brush up on health insurance basics, use the subsidy calculator, or shop for a health plan. We also have helpful plan information available in Spanish.
- Phone. If you’d rather talk this out with an expert, we have licensed agents you can call. For English, call 1-888-475-6206. For Spanish, dial 1-844-315-4884.
- In person. Prefer to huddle with one of our experts in person? You can either come to us, or we can come to you! Visit us at Independence LIVE, our new customer experience center in Philadelphia, or see when the Independence Express will be in your neighborhood.