How to Choose Health Insurance: A Full Guide on Picking Plans

Getting health insurance can be stressful, but we're here to help simplify the process. This guide covers how to choose health insurance.

Health insurance can be crucial to have, especially in the United States. Luckily, most Americans do have this. In 2021, that number was up to nearly 92% of Americans.

However, if you do not know much about a health insurance plan, or if you have the option to enroll in a new health plan due to a job, education, or family change, you may be wondering how to choose health insurance.

This guide will show you why health insurance is essential for you to have, what you should look for in a plan, and how you can tell what stands out.

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What Does Health Insurance Do?

First off, we should talk about what health coverage does for you. Some people, particularly younger people, may be wondering why you need health insurance in the first place.

Well, the short answer is that health insurance financially protects you from unexpected emergencies. This can be anything from having an accident that requires immediate surgery to a sudden serious illness to airlift transportation to a hospital to make sure that you survive. It’s anything where your safety and well-being are at risk.

Health insurance is very important if a major issue like the above comes up. The reason is that if you do not have this, you are going to have to pay the bill yourself.

For example, the average airlift to a hospital just to travel 50 miles can cost up to $25,000. Not everybody has that kind of money lying around. Health insurance can protect you from being on the hook for serious medical bills.

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Know What You Need to Know About Health Care

When it comes to choosing health insurance, it is important to know yourself and know your family. This can be one spouse getting on a company plan for their entire family, or a parent trying to pick a plan that will benefit both them and their children.

To do this, you need to know the health requirements of everybody that is going to be on this plan. You also need to have an idea of who can be on your plan.

Let’s use children as an example. Children can stay on their parent’s health insurance plan until they are 26 years old. So, until that day comes, you can work with your children’s best health interests in mind for this plan.

In this situation, you can start to consider what your children need more.

Do you need a plan that has regular dental coverage? What about a plan that caters to kids with asthma? What if they have a severe physical condition such as cerebral palsy?

These are things that you are going to have to think about if you want other members of your family on your plan.

Then, you will have to stop and think about what you are going to need to be covered. Considering that you should know your body better than anybody, this should be something simple for you.

Think about what conditions you tend to suffer from and what you may be prone to in the future. While it is impossible to foresee everything, you can at least get a good idea of the basic and obvious things that you are going to need as part of your health insurance plan.

Consider the Cost of Premiums

The next thing that you need to think about is how much the cost of premiums would be for your health insurance plan. Considering that people could have an age difference of as much as 70 years here, it is obviously going to vary based on that and certain health conditions that you already have.

However, for an average middle-aged adult, it still may not be cheap to cover premiums. That is because these premiums can cost over $6,000 per year. This also means that you could have to dedicate over $500 per month to health insurance premium payments if you are covering this yourself.

This can be a problem for those that do not have the income to cover it but make enough money to be disqualified for certain coverage from the state. We will get to that later.

Considering that the United States has one of the highest average out-of-pocket costs of health insurance plans in the world, this is something that you may have to think about. With this, you are going to have to weigh how much you need coverage.

Are you confident that you will not need maximum protection and coverage from your health insurance plan? Or, are you somebody that does not get sick or injured too often and is willing to take on a higher cost when and if that time comes?

These are things that you need to think about with premiums. Premiums can provide a great safety net to those that think they are going to need it. However, others may believe that the money they spend on that is better elsewhere.

This is where we get into our next category.

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Consider the Cost of Deductibles

If you think the cost of premiums described above is too high, you may want to consider going toward a plan that has a higher deductible than a higher premium.

A deductible rewards people that only want to pay for what they use. It is essentially the money that you have to put down toward certain healthcare expenses before insurance will start chipping in.

The catch with these types of plans is that when you actually do need coverage, you could get hit with a very high deductible. It could even get to the point where the cost of that was more than the health insurance plan you may have been paying for all year.

For example, let’s say that on your health insurance policy, your deductible was $5,000. Let’s also say that you would have been paying around $4,000 per year in premiums had you elected to go with another plan.

In this scenario, you end up getting hurt and getting hit with a major medical bill. Now, you are going to have to pay that full deductible before your insurance contributes any money.

The worst part of this example could be that your total hospital bill was $6,000. In other words, you could have had nearly everything covered with a premium rather than going with a deductible plan.

However, if you avoid any serious injuries or medical issues for a couple of years, the savings on these plans could be worth the money. This is something that you are going to have to decide for yourself when picking a health coverage plan.

Health Care Co-Pay vs. Coinsurance

Going off of the above, sometimes, you get to have the best of both worlds. You can have a premium that covers most of your healthcare expenses while having co-pay or coinsurance being a small contribution on your end each time you have a healthcare expense.

This is usually used for more minor healthcare expenses rather than big hospital bills. It can be things such as prescription medication or a doctor’s visit that you do not have too often.

You need to do two things here. The first is to decide which of these two things that you would rather have on your health plan.

Co-pay requires a flat fee to be paid by you every time you have a healthcare expense that qualifies for this. This can be beneficial for those who tend to fluctuate when it comes to out-of-pocket healthcare expenses.

Then, you have coinsurance. This works differently because it requires you to pay a certain percentage of each healthcare expense rather than paying the same amount every time that you have an expense.

This type of healthcare plan can work better for those that are on a more consistent payment schedule when it comes to their healthcare.

You need to think about what arrangement works better for you in this situation. You may even need to consider your financial situation before choosing one because it can affect when money comes in and out of your bank account.

Medicaid Services

Something else that you may want to consider is applying for Medicaid. This can help you if you are financially struggling and you do not think you can afford to pay for health insurance on your own.

When it comes to Medicaid, there is a threshold you have to meet financially to qualify. Usually, this threshold is just above the poverty line.

If you look at the chart in the link above, you will see that this percentage depends on a couple of things.

The first thing that it will depend on is what state you are from. Each state has its own Medicaid program, so they make their own thresholds on what qualifies you financially. An example is as an adult with no children, you can be up to 133% over the federal poverty line in New Jersey while you can be 200% over it in New York.

This is typically factored by the average cost of living in each state. Considering that New York is one of the most expensive states in the country to live in, it is no surprise that it is a higher percentage than most.

Another factor you will have to consider here is if any children are on your plan. Parents that have children may get a different rate from those who are single adults.

Part of the factor here is how old your children are. There are ranges from newborns to kids ages 1-5 to kids ages 6-18. Depending on how old that child is and if you are a single parent, you could see that you have a different eligibility status than other people in the same financial bracket.

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Network Plan

When it comes to health coverage, it is important to consider if your plan is going to be in-network with a lot of the healthcare facilities that you go to. Whether this is a doctor’s office, dental visit, or picking up your medication, there are usually signs in any facility that state what healthcare policies are in their network and which are considered out-of-network providers.

If you find yourself going somewhere on a regular basis, this is your biggest sign to check what healthcare plans a place accepts. The reason for this is that if you go to a place that is not in network with your healthcare plan, you could end up paying for the entire cost of your visit yourself.

There are certain doctors, dentists, and healthcare facilities that get a friendly deal or friendly benefits from certain healthcare providers. In turn, they accept those plans from customers and choose not to accept other providers that are more difficult to deal with.

Try to take notes of what each healthcare facility that you go to accepts as part of their network. Then, once you put the pieces together on this, you can make a more informed decision about what healthcare provider you are going to go with.

Employer Healthcare Options

You may work for a company that actually offers you healthcare provider options. There are many to choose from here and the best part is that no matter what you go with, you are going to have relatively minimal costs for your health insurance.

However, there are two types of plans that you should know about if you do have the option to choose. We will go over those below so you can compare plans.

Health Maintenance Organization

This is one of the types of health insurance plans typically offered by an employer. The employer usually has a deal or a good rate with this type of package, so this is what they tend to provide their employees.

What you need to know about a health maintenance organization is that you typically need to stay in the network to get decent coverage. Sometimes, there is an exclusive provider in this organization that you have to use to avoid paying significant out-of-pocket costs.

As you can see, the main downside with this type of plan is that you do not get a lot of freedom when it comes to what healthcare provider you will use. The decision is basically being made for you unless you want to take on those out-of-pocket costs.

However, there is still a positive side to this. The good thing about a health maintenance organization is that if you do stay in the network, you will pay next to nothing to receive healthcare. You will likely only have to make a small co-payment with this type of plan.

Along with this, you have the option of getting assigned a primary doctor to take care of you. This can be good if you are going in for regular visits and you want someone that knows your medical history.

It is up to you to decide if the benefits outweigh the cons here.

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Preferred Provider Organization

Another type of organization that you can go with is a preferred provider organization. This works a little bit differently than a health maintenance organization because, with this type of healthcare plan, you are given more freedom.

What do we mean by this? In the above plan, you can only use providers that are in your network. Sometimes, you may be stuck using an exclusive provider.

With this type of plan, you are allowed to go to providers that are out of your network and still get coverage. With the above plan, you would be looking at significant out-of-pocket costs.

The way this one works is that if you decide to use a provider that is out of your network, it is still going to be more expensive than using one in the network. However, you will not have to pay nearly as much out-of-pocket costs if you decide to go this route.

There is still one con with this plan though. When it comes to the out-of-pocket costs for providers in your network, that will be more expensive with this type of plan.

Essentially, you have to make a choice if you do get the option here. You can either take a plan that has less freedom but next to nothing in out-of-pocket costs in your network. Or, you can take a plan that has more flexibility but you will have to pay for those higher out-of-pocket costs in your network.

ACA Compliance

ACA stands for the Affordable Care Act. It is also known as Obamacare. What this does is it gives everybody the right to have affordable healthcare and healthcare providers have to follow the regulations here.

This can also affect you if you work for an employer. That is because, in some situations, employers may be denying you reasonable access to affordable healthcare. There are certain conditions that if an employer fulfills, they are obligated to give their employees some sort of healthcare.

However, this does not just affect people that are trying to take an employer’s plan. You need to look out for yourself and make sure that the healthcare plan you get is ACA-compliant. The reason is that if it is not compliant with the ACA, then you risk your healthcare plan being null and void.

You have to make sure that you read the fine print in your healthcare plan very carefully. There could be small details in your contract that can hint that it is not ACA-compliant.

Of course, this may be very difficult for you to do yourself. If you find that to be the case, perhaps go to a healthcare professional or even visit a contract lawyer to make sure that everything in that contract is legitimate.

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Short-Term Health Insurance

Something else that you may consider is getting a short-term health insurance plan. You are going to want to look at the fine print of these carefully. Short-term plans tend to be one of the most common ones that are not compliant with the ACA.

As long as it is compliant, there are some good benefits to going with a plan like this.

Other plans may lock you down for a year or so. You may not be someone that is going to be in the area for that long. You could be someone that travels a lot.

If this is you, having short-term health insurance can be great for you because you are not stuck paying the premiums as you are with a longer plan. You could be someone that likes to travel internationally where that insurance is rarely accepted. Or you could be planning a big move soon and want to avoid being tied down to one plan.

Whatever the case may be here, short-term health insurance can be great for those that are on the move. However, make sure that you check the legality of this type of plan in your state. There are certain states that do not allow people to have this type of plan.

Make sure that you are in a state where it is legal to have this plan. Failure to do this would result in your health insurance being invalid.

Learn More About How to Choose Health Insurance

These are the biggest things that you need to keep in mind when it comes to how to choose health insurance.

Think about the deductibles and premiums you would be expected to pay for each. On top of that, make sure your plan is ACA-compliant and legal in your area. If you are going with an employer’s plan, review that section carefully to find the right fit for you.

We hope this article has given you a great beginner’s guide on how to choose a health insurance plan! Keep checking out the Goodwall Blog to find more articles on self-improvement topics and more.

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Goodwall Team
Written By Goodwall Team
This article was written by the Goodwall team or by a contributor for publication on Goodwall. Goodwall is dedicated to helping students, entrepreneurs, and young professionals reach their full potential. We'll share thought-provoking and supportive articles on career advice, self-improvement, navigating the college landscape, climate action, social impact, and more. On the business side, we'll talk about SMB subjects related to community, diversity, talent acquisition, case studies, and enterprise.

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