If you don’t have a preferred doctor, look for a plan with a large network so you have more choices. A larger network is especially important if you live in a rural community, since you’ll be more likely to find a local doctor who takes your plan.
Eliminate any plans that don’t have local in-network doctors, if possible, and those with very few provider options compared with other plans.
Step 4: Compare out-of-pocket costs
Out-of-pocket costs are nearly as important as the network. Any plan’s summary of benefits should clearly lay out how much you’ll have to pay out of pocket for services. The federal marketplace website offers snapshots of these costs for comparison, as do many state marketplaces.
This is where it’s useful to know a few health insurance vocabulary words. As the consumer, your portion of costs consists of the deductible, copayments and coinsurance. The total you can spend out of pocket in a year is limited, and that out-of-pocket maximum is also listed in your plan information. In general, the lower your premium, the higher your out-of-pocket costs.
Your goal during this step is to narrow down choices based on out-of-pocket costs. A plan that pays a higher portion of your medical costs, but has higher monthly premiums, may be better if:
- You see a primary physician or a specialist frequently.
- You frequently need emergency care.
- You take expensive or brand-name medications on a regular basis.
- You are expecting a baby, plan to have a baby or have small children.
- You have a planned surgery coming up.
- You’ve been diagnosed with a chronic condition such as diabetes or cancer.
A plan with higher out-of-pocket costs and lower monthly premiums might be the better choice if:
- You can’t afford the higher monthly premiums for a plan with lower out-of-pocket costs.
- You are in good health and rarely see a doctor.
Step 5: Compare benefits
By now, you likely have your options narrowed to just a few. To further winnow down, go back to that summary of benefits to see if any of the plans cover a wider scope of services. Some may have better coverage for things like physical therapy, fertility treatments or mental health care, while others might have better emergency coverage.
If you skip this quick but important step, you could miss out on a plan that’s much better suited to you and your family.