Couple Looking over Health Insurance Plan options

What to Look for in a Health Insurance Plan

Choosing a health insurance plan is a big decision that directly impacts your
well-being and financial security. But don’t worry, Woligo has your back!

Whether you’re selecting a plan for the first time or want to see if there are
better options available, this article will help you consider some of the most
important factors before choosing the best health insurance for your needs

How to choose a health insurance plan

There could be hundreds of available health insurance plans for you to
choose from, but which one is the right choice? Choosing a health insurance
plan can feel overwhelming, but breaking it down into steps can simplify the

  • Step 1: Evaluate current health insurance coverage (if applicable)
  • Step 2: Get a quote
  • Step 3: Compare available health plans
  • Step 4: Enroll and pay your first premium before the deadline!

Step 1: Evaluate current health insurance coverage (if applicable)

If you have existing health insurance, the first step is to evaluate your
current coverage. Note what you like and dislike about your current plan, any
issues you’ve encountered, and any changes in coverage over the past year.
Some questions to ask yourself:

  • Did I encounter any unexpected or high out-of-pocket costs?
  • Did I face challenges in finding in-network specialists or facilities?
  • Were my preferred healthcare providers readily accessible within the plan’s network?
  • How well does my plan cover the cost of my prescription medications?
  • Have I faced any limitations or challenges in managing chronic conditions under my current coverage?
  • How well did my plan cover emergency room visits and urgent care services?
  • If applicable, have any referral requirements posed challenges in accessing necessary care?
  • How well did my plan cover healthcare services while I was traveling?
  • What were my total out-of-pocket expenses for the past year, including deductibles, copayments, and coinsurance?

These insights can help you better understand what you want and need
when it comes to taking care of your health.

Step 2: Get a quote

Before you can compare health plans, you need to find out what plans are
available in your area. After answering some questions online, you can get a
no-obligation, free quote
delivered directly to your inbox.

(Example of online health insurance quotes.)

Don’t settle for the first plan you come across. Compare multiple plans to find the one that best fits your needs and budget.

Step 3: Compare available health plans

You don’t have to be a health insurance expert (that’s our job!), but
understanding the different components of health insurance can help you
make an informed decision year after year. These include:

  • Health insurance plan categories (metal levels)
  • Types of health insurance plans
  • Specific health insurance benefits
  • Total cost

Health insurance plan categories (metal levels)

If you are looking for individual health insurance from the Marketplace –
there are four categories of health insurance plans (also known as metal
levels) for you to choose from: Bronze, Silver, Gold, and Platinum.

These metal levels have nothing to do with the quality of care and all to do
with how you and your plan share costs. A bronze plan typically offers the
lowest monthly premium but the highest costs when you need care. A silver
plan typically offers a moderate monthly premium and moderate costs when
you need care. A gold plan typically offers a higher monthly premium but
lower costs when you need care, and a platinum plan offers the
highest monthly premium but the lowest costs when you get care.

Plans in all categories have a wide range of deductibles,
copayments/coinsurance, and out-of-pocket maximums. That’s why we wrote
an entire article about ACA Health Plan Categories (Metal Levels) –
check it out!

Types of health insurance plans

Different types of Marketplace health insurance plans are designed to meet different needs. Some plans restrict your provider choices or encourage you to get care from the plan’s network of service providers.

The most common types of health insurance plans are Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO), and Point of Service (POS) plans.

  • A Preferred Provider Organization (PPO) is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers.
  • A Health Maintenance Organization (HMO) is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO.
  • An Exclusive Provider Organization (EPO) Plan is a managed care plan where services are only covered if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
  • A Point of Service (POS) Plan is a plan in which you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network.

Understanding the different types of health insurance plans will help you make an informed decision when it comes to the right individual health insurance plan for you and your family.

Specific health insurance benefits

Each health insurance plan offers a unique array of benefits, such as coverage for preventive care, prescription drugs, specialist visits, and hospitalization. It’s important to pay close attention to the specific health insurance benefits to make sure they align with your healthcare needs.

For example, if you take prescription medications regularly, you’ll want to ensure they are covered and check how much they would cost. If you have a favorite doctor, you’ll want to ensure they are in-network for your plan so you can continue seeing them. Other benefits to carefully evaluate include, but are not limited to:

  • Network: Check if your preferred doctors, specialists, and hospitals are in the plan’s network. Using in-network providers can save you money.
  • Coverage for specific services: Review what specific services are covered, including doctor visits, preventive care, and other medical needs.
  • Prescription drug coverage: If you take prescription medications regularly, ensure your drugs are covered and check the associated costs.
  • Coverage for chronic conditions: If you have a chronic illness, evaluate how well the plan covers the ongoing care and medications you require.
  • Telehealth and virtual care: Inquire about telehealth options for remote medical consultations, which can be convenient for independent contractors.
  • Wellness programs: Some plans offer wellness programs that may provide incentives for healthy behavior and lifestyle choices.
  • Emergency coverage: Understand how emergency care is covered, including out-of-network emergencies, which can be crucial for unexpected situations.

It’s also important to be aware of any policy exclusions and limitations. Check to see if there are specific conditions or treatments not covered by a plan you are considering, and determine how that may impact your out-of-pocket costs if that is something you may need.

Total cost of health insurance

When choosing a health insurance plan, it’s a good idea to consider your total health care costs for the entire year and determine how much you can afford to pay. After all, monthly premiums are not the only cost to you. Additional costs to consider include:

  • Monthly premium x 12 months: The amount you pay to your insurance company each month to have health insurance.
  • Deductible: The amount you have to spend for covered health services before your insurance company pays anything (except covered preventive services).
  • Copayments and coinsurance: Payments you make to your health care provider each time you get care, like $20 for a doctor visit or 30% of hospital charges.
  • Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.

It’s important to balance your healthcare needs with your financial constraints.

Consider future needs

Consider how your health and financial situation may change in the coming year. Health needs evolve, and having insurance that aligns with potential future requirements ensures comprehensive care and financial security. Factors like family planning, possible illnesses, or changes in healthcare needs due to age are essential considerations.

Guide to health insurance terms

We want to make your health insurance journey as easy as possible, so we created a guide to help explain some of the most common health insurance terms to help you on your health insurance journey.

Woligo is here to help

It’s essential to thoroughly assess healthcare needs and review plan details to select the best health insurance coverage for your specific needs. Woligo Insurance Pros are standing by to offer guidance or to answer any questions you may have.