Health Insurance Healthcare

How to Choose Your Medical Insurance Plan

How to Choose Your Medical Insurance Plan
Written by Guest Author

Everyone needs health insurance, and you typically have a limited time to choose the best plan for your needs. However, making a rushed decision based on how much it will cost you each month could be a mistake. Picking the wrong insurance plan may cost you thousands of dollars on any potential hospital bills, leaving you having to pay tons of money before your insurance starts to pay for some of the costs associated with your care.

Even though you don’t expect to be hospitalized or end up sick and in need of medical care, anything can happen to you. Finding the right insurance plan is key to ensuring you won’t risk your family’s financial health if you need specialized and more expensive care. Here’s how to choose your medical insurance plan. 

Go Through Your Employer

Saving money when you can should always be a priority, so getting insurance through your employer is typically the best way to get health insurance as they’ll cover some of the monthly costs. In addition, plans offered by employers are cheaper than those in the marketplace, and the plans are typically better with lower monthly payments and deductibles. 

Unfortunately, not everyone has an employer-sponsored healthcare plan available to them, so you might have to go through an online marketplace like or by purchasing insurance through a private exchange or direct from the insurance company. Unfortunately, if you don’t use the marketplace, you won’t have the potential to get tax credits based on your income. 

Compare Plans

Whether you’re using the marketplace or not, your health insurance options and rates may depend on your medical history. Those with preexisting conditions typically pay more for health insurance because insurers will have to pay specialists more money for more frequent treatment. So, for example, if you need an oncology specialist, your health insurance premium will be more expensive than someone who doesn’t have a preexisting condition. That being said, you should have a few healthcare plans to choose from, no matter what your medical history says. 

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Unfortunately, comparing medical insurance plans can be difficult because you may not understand all the abbreviations and terms presented to you when looking for the best plan. The most common types of insurance policies are:

  • HMOs
  • PPOs
  • EPOs
  • POS

The type of plan you choose will directly affect the cost. The most expensive type of coverage is typically a PPO because you don’t have to stay in-network to get coverage. HMO, another popular choice, requires you to stay in-network for coverage unless in emergency situations. HMOs also require you to get a referral to see specialists before the plan will cover your costs. 

Meanwhile, EPOs have a lower out-of-pocket expense and don’t require referrals, but you have fewer options when choosing your care provider. POS plans have more provider options, but you’ll have to get your care from an in-network doctor. 

Understanding the different types of insurance policies takes time, but essentially they determine your out-of-pocket expenses and which doctors you can see. 

Summary of Benefits

When comparing plans, always check the summary of benefits that will explain the different costs and coverages associated with each plan. You can even search for your primary care physician (PCP) to determine which insurance they accept before you choose a plan. If you’re going through an employer-sponsored plan, you may have to speak to your benefits administrator to receive the summary of benefits and learn more about the plan. 

Predict Medical Expenses

You can’t predict every medical expense, but you can determine which plan is right for you and your family based on past treatment. Look at the types of treatment you and everyone else who will be on your plan have had in the past few years. While it’s impossible to predict the future, you can still remain aware of certain medical trends in your family to help you choose the best plan. 

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Compare Networks

Comparing plans is essential, but you may also choose to compare the different insurance plan networks. The network refers to the providers and different care facilities your health plan works with. If your PCP is out of a plan’s network, you’ll likely have to pay the entire cost of care out of pocket, making your health insurance less useful. 

If you’re trying to save money on medical care, it’s best to go to an in-network doctor since insurance companies have already negotiated lower rates with those providers. When you get out-of-network medical care, your doctors don’t have those negotiated rates and will give you a higher bill. 

If you want to keep your current PCP, always ensure they’re in the provider directory of your network or the network of the plan you’re considering.You can also call your doctor’s office to determine whether or not they’d take your new type of insurance. Either way, you will want to choose a physician that has your best interests in mind; Physicians partake in a curbside consult when they need advice from another physician on how to best treat a patient may be such a physician. 

Check Costs

One of the most important factors when choosing a healthcare plan is the out-of-pocket costs. These are the costs that are what it will cost you to see your healthcare provider; they are not your monthly premium. The summary of benefits of a plan will lay out how much it will cost to pay out of pocket for healthcare services, and if you’re using the marketplace, you can look at these costs and compare them on the same screen. A few different out-of-pocket costs to consider are:

  • Copay: Copay is the flat fee that you’ll pay every time you go to the doctor. 
  • Coinsurance: Coinsurance is the percentage of the medical bill that you pay out of pocket, with the rest being paid by your insurance plan. 
  • Deductible: The deductible is the amount you pay for medicare care before your insurance plan starts paying for it. 
  • Out-of-pocket maximum: The out-of-pocket maximum is the most you’ll pay out of your own pocket for all covered healthcare services. 
  • Premium: Your premium is the monthly cost of your health insurance. 
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Most people care most about their health insurance premiums because that’s the cost they have to pay every month to remain insured. Typically, the more you pay monthly, the better your coverage. A plan that will pay more of your medical costs will have a higher monthly premium, but it might be beneficial for those who see specialists frequently or are planning a major surgery. 

Lower monthly premiums typically mean higher out-of-pocket expenses, and you’ll have to pay more out of your own pocket before your insurance will start to cover your medical expenses. 

Choosing Your Medical Insurance Plan

You should compare the different medical insurance plans available to you on a yearly basis to ensure you’re getting the best insurance for yourself and your family. Before you decide on any type of insurance, plan, or network, always do your research and compare the different benefits and costs.

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