Figuring out which health plan will give you the coverage you need at a price you can afford can be complicated. An important first step is to compare how much you will pay on a monthly basis for your premium. But you will also pay additional costs (called out-of-pocket costs) throughout the year as you receive care.
Your out-of-pocket costs come in three forms:
- Deductible—The amount you have to pay each year before your insurance kicks in.
- Co-pay—The flat fee you pay at the time of service.
- Coinsurance—The percentage that you must cover, after you have met your deductible, with your insurance company paying the rest.
You should know that lower premiums often mean higher out-of-pocket costs. So weigh your options carefully before picking the plan with the lowest premium.
A higher premium plan with lower out-of-pocket costs might be right for you if you need frequent health care or expensive procedures. For example, if you or one of your family members:
- Expect or plan to have a baby
- Are planning a surgery
- Received a new diagnosis like diabetes or cancer
- See a specialist on a regular basis
- Frequently need emergency care
- Take expensive or brand-named medications on a regular basis
A lower premium plan with higher out-of-pocket costs might be right for you if you and your family members:
- Do not need frequent health care
- Are in generally good health and rarely see a doctor
- Do not often participate in activities with a high risk of injury
You may also choose a lower premium plan with a high-deductible, and put money into a health savings account (HSA) or flexible spending account (FSA), designed to help you save money for health expenses that you can withdraw when you need them.
To help you make an informed decision, use the Community Checkup to look at how individual health plans score on measures relevant to you.