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Choosing a Health Insurance Plan 101

Written by Bedsider on November 8th, 2019

It's time to go shopping! Here are four questions to help you pick a plan.

The Affordable Care Act’s open enrollment period is open, but you only have until December 15, 2018 to get coverage for next year through your state marketplace—so if you're uninsured or interested in finding a better plan, it's time to shop!

To get coverage, all you have to do is visit and fill out an application. (By sharing basic demographic and income information, you can also find out if you’re eligible for financial help to make your plan more affordable.) The next step is to choose a health plan based on your budget and your individual health needs.

The following four questions can help you decide which health plan is the best choice for you and your family:

1. How much health care do I need?

The health plan that’s best for you depends on how much health care you need and on the type of health services you’re likely to access.

  • Do you expect to visit a health care provider often? You may want to consider a gold or platinum plan, which require a higher monthly premium payment and cover a larger percentage of your health care costs, leaving you with fewer out-of-pocket expenses.

  • Do you only go to the doctor once a year? A lower-premium bronze or silver plan may be a better fit.

Remember: Regardless of which level plan you choose, your birth control and other key preventive services should be covered without additional out-of-pocket costs.

2. Is my preferred brand of birth control covered?

While health plans are required to cover all FDA-approved methods of contraception without any cost-sharing, not every plan covers all brands of contraceptives. For example, there are dozens of brands of birth control pills, including generic versions of name brands. If you strongly prefer a specific brand of birth control, you should check to see if that brand is covered by the plan you are considering.

3. How important is it to me to stick with my current doctor?

Ask yourself how important it is to you to keep your current health care provider. Are you willing to look for a new one? If not, you may want to make sure that your provider is “in-network.” (If you visit a provider who is “out-of-network,” you might have to pay more.)

Health plans offered in the marketplace are responsible for providing a list of participating in-network providers. If you can’t find the list online, call the call center at 1-800-318-2596 or the insurance company for help.

4. Am I expecting any major life events in the coming year?

Life-changing events may cause you to need more health care than you usually do. For example, if you’re planning on having a baby, you may want to choose a more robust health plan that will cover a greater portion of the out-of-pocket costs for maternity care.

The Affordable Care Act requires all health plans to cover maternity services as an essential health benefit. However, exactly which maternity care services are covered by plans will vary from state to state. Make sure to ask a representative from a health plan to verify exactly what types of services are covered under its maternity care benefit. The cost of pregnancy and labor and delivery can be very high if you have to pay for it out-of-pocket, so you’ll want to know what a plan covers before you purchase it.

Even if you don’t need maternity care now, you might in the future. And of course, if you’re not planning to get pregnant, make sure your birth control is covered.

Once you’ve answered these important questions, you should be set to choose the plan that’s right for you.

If you miss the open enrollment period for 2019, you may still be able to get coverage. Find out if you could be eligible for special enrollment.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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