Big decision- Health plan selection!

Updated: Dec 1, 2018


Selecting the right health plan is vital!

Choosing the right health plan is a big decision that can impact your family’s health and financial situation for the year. Before selecting a health plan for your family, it’s critical you know and can anticipate your family’s healthcare needs. Knowing things like your family history, potential risk factors, and preferred doctors are all essential factors that will help you choose the right health plan. For example, if your child has allergies, you’ll want to include a plan that allows for specialist doctor visits that won’t break your bank. After outlining your needs, you’ll want to compare health-plans that accommodate them at the most reasonable cost to you.


Some plans might have higher deductibles but come with better prescription plans. For a family member that requires an expensive medication, choosing this kind of plan might be the better option. If you or a family member find yourselves in and out of the doctor’s office, a plan that has a higher premium might save you in the long run. If you or anyone in your family has high medical needs, look for a policy that has lower total cost-sharing amounts when considered as a group. Keep in mind that your actual total costs include the sum of the premium, the deductible, the co-payments and coinsurance, all up to your out-of-pocket max.


Questions to Ask Yourself When Choosing a Plan

1. What is the deductible that I must meet first before my insurance starts to pay? Do I have a separate medication deductible and a medical deductible?

2. What are the out-of-pocket costs for providers, specifically co-payments and co-insurance amounts? What is an estimate for the total of these amounts?

3. Is my preferred doctor(s) in the plan network? (If you do choose to use a doctor that is out-of-network, you’ll want to understand how much will be reimbursed by the plan)

4. How much is my monthly premium? Do I qualify for any premium tax credits?

5. Do I need a referral to see a specialist?

6. Does my plan offer access to the specialists I need or want to meet?

7. Are the prescriptions I’m current taking covered by the plan? (Are they listed on the plan wordings?)

8. Does my plan include coverage if I have to visit an out-of-network provider, even for urgent or emergency care?

9. Does my plan qualify me for additional saving options like Health Savings Accounts, Flexible Spending Accounts or Cafeteria plans?

10. What do I need for dental or vision coverage? (If beyond annual checkups, you might need to get a separate plan to address these services, as health plans have minimal benefits in these areas.)

Tools to Help You Compare

Finder.Healthcare.gov allows you to compare plans side by side, and contains tools to help you analyze how medical expenses impact your family’s budget.

CancerInsuranceChecklist.org provides guidance on the important items to consider in your plan options when diagnosed with a serious condition, even if not cancer related.

www.nerdwallet.healthsherpa.com is an online tool that will present you with plan recommendations in your area.

A downloadable spreadsheet tool can be found at www.businessinsider.com/spreadsheet-for-pickingperfect-healthcare-plan-2016-11 that helps capture and calculate your expenses.

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Office: San Jose CA, 95124

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