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  • Writer's pictureJo Soria

What to Know Before You Pick a Health Insurance Plan

Updated: Apr 19

If researching and picking a health insurance plan is on your list of least favorite chores—like right after brushing your dog's teeth, for example—this one's for you.


Join the Trusted Referral Network team as we explore the prep steps for choosing the right coverage for yourself or your family.

Picking apple from tree like picking health insurance plan

Healthcare Consideration #1: What will your life look like over the Next Year?

Though none of us have a crystal ball, and there are plenty of pleasant (and less pleasant) surprises we may encounter in any given year, it's still essential to think about the plans and possibilities.


Here are some pretty common life events that could affect your healthcare-related decisions. By incorporating them into your plans ahead of time, you may be able to avoid some costly mistakes or surprises down the road:


Family Growth

Are you considering having a child, adopting, or caring for an elderly relative? Expanded family calls for extended care. You may need to revisit your healthcare plan to ensure it covers the additional services you'll need.


Suppose you'll be supporting or taking over the care of an elderly relative. In that case, while you may not need to factor them into your insurance plan, you may need to be involved in administering their Medicare or SSI benefits. It will likely benefit you to begin learning how to navigate their healthcare systems in addition to your own.


Divorce

Are you divorcing or changing custody agreements? If you were previously part of a family plan, ensure that you have your healthcare coverage and that arrangements are made for how coverage will continue for any dependents.


Surgery or Chronic Illness

Upcoming surgery or chronic illness diagnosis? This could involve looking for a plan with more in-network providers and specialists, seeking a lower deductible, and/or checking the copays and coverage of prescription medications you'll need.


Changes to Employment

Are you planning to enter or exit the full-time workforce in the next year? Either option may affect your health coverage. If you're planning to take a full-time job, your employer may sponsor your healthcare and at least some of the expenses. Be sure to assess all of your options, and if your employer has a benefits coordinator, you can request a consultation with them to answer additional questions.


If you're exiting the workforce and no longer have employer-provided coverage, you can secure your coverage through the Affordable Care Act's (ACA) Marketplace. For some of our top tips on selecting a Marketplace plan, look here and here.


Relocation

Relocations happen for numerous reasons: job transfer, new job, opening a new business, moving to be near family, and the list goes on and on. Amid big moving decisions, healthcare can often get lost in the mix, but remember to consider your projected expenses and ensure you can still maintain your healthcare coverage.


Depending on your healthcare needs, you may also need to do some advanced research on the provider networks in your new area.


RELATED: 5 Secrets to Finding the Right Health Insurance for Your Family


Girl holding apples

Healthcare Consideration #2: What Else Will You Need From Your Coverage?

Now that you've thought about what the year ahead may look like and how that may factor into your healthcare needs, let's take it further.


Know Your Network

If you're shopping for a new healthcare plan but definitely don't want to switch the primary care provider or specialist you're seeing, it's homework time! If your heart is set on staying with your current physician or specialists, make sure that:

  • They're listed as an in-network provider under your new insurance plan, or

  • You know and are willing to accept the additional amount you'll have to pay out of pocket to continue seeing your doctor/s if your new plan lists them as out-of-network providers.

HMO vs. PPO?

Like knowing your network, understanding the choice between HMOs and PPOs may go a long way in helping you narrow your options to the most practical. In a nutshell: Health Maintenance Organizations (HMOs) tend to be a little less expensive than PPOs. The tradeoff? They also tend to be more restrictive about the providers (physicians, specialists) you can see while seeking coverage. If you see a care provider outside the designated HMO "network," you may be footing the entire bill.


Planned Provider Organizations (PPOs), on the other hand, tend to allow more choices and broader networks of allowable care providers. And even if you choose a provider outside your network, your PPO may kick in for some cost-sharing that an HMO wouldn't. The tradeoff? Prepare to pay more for a PPO than you would for an HMO. When choosing between the two, consider whether your family may need specialized care and how much control you'll need when selecting your providers.


Healthcare Consideration #3: How Do Your Finances Factor When You Pick Health Insurance?

Now let's take a closer look at the financial piece of the pie as you nail down your healthcare planning.


Premiums vs. Deductibles

There is generally an inverse or tradeoff relationship between your monthly premium and deductible. Generally speaking, the higher your monthly premium on maintaining your insurance policy, the lower your deductible and out-of-pocket expenses will be if and when you need to seek care.


Take some time to think about what you can afford every month, as well as those healthcare considerations we previously outlined. Consider whether you're a single plan holder who only seeks an annual checkup or if you have a family, a needed surgery, a chronic condition, or something more involved. Consider whether you can realistically afford the deductible and out-of-pocket expenses if you need help beyond preventative care. Or, for an easy breakdown of the plan categories in the Marketplace, look here.


Family Plans

Remember that your plan may have a family deductible in addition to individual deductibles for each family member. Many times, individual deductibles are lower than the family deductible. Once an individual hits their deductible, their health insurance plan kicks in just for them. But once the family deductible is met, health insurance kicks in for every family member, regardless of whether or not someone has reached their deductible on their level.

Finished apple pie with basket of apples after picking insurance

Healthcare Consideration #4: Where Can You Get Extra Help?

Still confused or anxious about choosing a plan? Why consult a professional? When you decide to work with a licensed health insurance agent, you get all the expertise on your side, with less than half of the homework involved.


A common misconception is that you must pay an insurance agent out of your own pocket. But when you work with a licensed, reputable, well-reviewed agent, you shouldn't have to pay for more than the costs associated with your health insurance plan, like premiums and deductibles. If you'd like help choosing an agent, we've got your back.


NEXT: So Metal: Your Backstage Pass to Understanding All Those Healthcare Options

 

Want to be a part of the #TRN Team? We are looking for guest writers to contribute to our blog. Reach out to jo@trustedreferral.org to learn more.

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