Whether you’re choosing a plan for the first time, or during your employer’s open enrollment period, it can be confusing. Use this checklist as a guide in making your decision.
1. Check to see if your providers are in-network.
In-network doctors or facilities may mean lower costs for you. Check each plan’s network to see if your healthcare providers are included, or if there is partial coverage for out-of-network care.
2. Think about your healthcare needs.
What do you see the doctor for?
- If mostly for minor needs:
You may need less coverage if you see the doctor only for a yearly checkup, minor illness or injury. To save money, you might choose a less costly plan with lower premiums in exchange for less coverage.
- If mostly for major or frequent needs:
You may need more coverage if you’re planning a major procedure, see the doctor often or take specialty medications. To save money overall, you may pay more in premiums in exchange for more coverage. These plans may have a lower deductible and out-of-pocket limit to help share your costs faster.
- Do you have a major procedure planned?
Research the average cost of care for the procedure, and consider a plan with a lower deductible and out-of-pocket limit so the plan will help share your costs faster.
- Do you take medications?
The cost of regular prescriptions or specialty medications varies based on each plan. Check to see if the plan covers generic and brand name versions. Also make sure your pharmacy is in-network, or your prescriptions may not be covered or cost more.
- Who else needs coverage through your plan?
The more people you have on your health plan, the more coverage you may want. Consider the needs of all family members covered by the plan.
3. Decide what your spending/saving priorities are.
- Is your priority a lower premium, taking less from your paychecks?
If you don’t have major care needs, a plan with a lower premium may provide enough coverage.
- Or is your priority to pay less overall for care services?
Consider each plan’s copayment amount, deductible, coinsurance and out-of-pocket limit to see which plans help you share costs faster. This also helps avoid cost surprises later.