Between deductibles, copays, provider networks, and coverage details, choosing a new insurance plan can feel overwhelming. It can be tempting to just pick the plan with the lowest monthly premium, but the plan you choose right now decides how much you can expect to spend on your healthcare for the next year. A plan that looks like a bargain on paper can end up being an expensive one for someone who has weekly appointments, so taking some time to compare your options now can make a big impact on your future expenses.
Here are a few things you should consider before choosing your next insurance plan:
Start with Your Healthcare Needs
Before comparing plans, take a moment to think about the care you use throughout the year. Nothing complicated, just a quick list to help you identify what matters most:
Do I see a primary care provider for annual checkups, or ongoing medical needs?
Do I have any specialty appointments, routine testing, or prescriptions to plan for?
Do I attend therapy, or plan on seeking mental health services in the coming year?
Am I currently receiving treatment that I want or need to continue?
Do I anticipate any major healthcare expenses?
Remember to consider all of your healthcare appointments, not just the ones you think of most often. All types of care, inducing lab work, prescription medication refills, or preventative care can play a role in your healthcare costs.
Look Beyond the Monthly Premium
Your monthly premium is the amount you pay to maintain your insurance coverage and while it’s an important part of your budget, it doesn’t tell the whole story.
A plan with a lower premium may come with a higher deductible, higher out-of-pocket costs, or a more limited provider network. A plan with a higher premium may offer lower costs for certain appointments or prescriptions. Which option makes the most sense depends on how you expect to use your insurance.
When comparing plans, be sure to look at these four details:
Monthly premium- What will you pay each month, even if you don’t visit a provider or use your insurance?
Deductible- How much will you need to pay for covered services before your insurance begins sharing the cost?
Copays and Coinsurance- What will you pay for appointments, prescriptions, and other covered services? A copay is a set amount, while coinsurance is a percentage of the allowed cost.
Out-of-pocket maximum- What is the most you could pay for covered services and other expenses that count toward your plan's limit? Premiums, noncovered services, and out-of-network expenses don’t count towards this total.
It can help to compare the estimated total cost of a plan over the entire year, not just the monthly payment. Also, consider whether you could comfortably afford a higher deductible if you need more care throughout the year.
Check That Your Providers Are In-Network
Being in-network generally means your provider has an agreement with your insurance company to accept negotiated rates for covered services. Receiving care out-of-network can mean paying more out of pocket, and some plans offer little or no reimbursement for out-of-network appointments.
This is especially important to check if you want to continue seeing your therapist, psychiatrist, primary care provider, or specialist. Switching providers because your new plan doesn’t include them can set back your progress, so it’s worth calling your provider’s office.
Be sure to check the specific plan you are considering, don’t just base it off of the carrier. A provider or office can be in-network with one plan and out-of-network with another under the same insurance company.
Not every service is billable to insurance, even if that office accepts your plan. At our practice, for example, services like IV ketamine infusions or wellness treatments are not billed to insurance. If you receive a covered service, like therapy, and also purchase services or items that aren’t covered, only the amount you paid for the covered service counts toward your deductible.
Make Use of the Resources Available to You
Remember, you don’t have to figure this out alone. Here are some resources you can turn to:
The member services line- The number is usually on the back of your insurance card or in your members portal. Representatives can explain your benefits and answer questions about specific services. If you’re comparing plans many carriers also have a pre-enrollment line.
Your employer’s HR or benefits team- They can walk you through the options available to you through work.
A licensed insurance broker- If you are buying coverage on your own, certified help is available to help walk you through the process and make recommendations based on your specific needs.
Open enrollment windows and deadlines vary depending on whether your coverage comes from an employer, the marketplace, or Medicare so be sure to confirm specific dates early rather than at the last minute.
The right plan is the one that lets you keep showing up for your healthcare without dreading the bill. That may not be the cheapest plan, or the same plan you chose last year, and that’s okay. What matters is that your providers are covered, your medications are affordable, and you know what a typical month will cost you. Taking the time to choose wisely this enrollment season is one of the most practical ways you can set yourself up for the year ahead.
If cost begins to be a barrier to care, speak with your providers early. Every provider has different protocols, but there are options and they may be able to help.
