Help! $#@&! How do I pick a plan?!?


While Open Enrollment is closed, life doesn’t stop. Maybe you’ve moved to a new county or state, lost a job, or gotten married. Maybe you just turned 26 and lost access to coverage on your parent’s plan.

Picking a health insurance plan is tricky, no matter when you have to do it.

I’ve talked with multiple people in the last few days who were feeling overwhelmed by the prospect, and I realized that the process I go through would make a good blog post.

Setting the Stage:

To begin with, I’m going to assume that you are applying for coverage on the Washington HealthPlanFinder. You may be using Healthcare.gov or another state’s Exchange website. They are all similar, but for now, let’s assume that you’ve filled out the application and are eligible to pick a new insurance plan. Where do you start??

The number of companies that will sell you a plan may be as few as 1 or 2, and as many as 8-9. When you are offered over 70 plans to choose from it can be a bit daunting. So how do you winnow down your choices?

Here are the questions I start with, along with clarifying questions at the end of the post. Make sure you consider all of your family members:

Do you have a doctor that you want to continue to see?

Do you take any medications?

How often do you see a doctor? Do you have any chronic conditions?

Should everyone be on the same policy?

What is your risk tolerance?

What is your budget?

Do you have any preferences?

Once you have answers to all of these questions you should be able to filter out a lot of the plans that don't work for you. Your choices should be reduced to a much more manageable number. You can then compare plans side by side to determine which one is right for you.

Still have questions? Still overwhelmed with options?

Don't hesitate to call your agent - that is what we are here for!

We can help you navigate your choices to find the best plan for your situation.

 

Do you have a doctor that you want to continue to see?

  • Filter out the plans that don’t cover you doctor. This may get rid of half of your choices. You may decide that it costs too much to continue to see your doctor and choose a plan that doesn’t cover them, but start by looking at the plans that will cover them.

  • Repeat for any other doctors. This gets a bit tricky since you can only filter on one doctor at a time. So grab a piece of paper and see if any companies and/or networks cover all of your doctors.

  • There may not be plans that cover all of your doctors. If this is the case, you will need to prioritize which doctors are most important.

  • Do you want to pay for a plan that has out-of-network benefits?

  • Do you want to find new doctors to replace the ones that are not covered?

  • Do you want to pay for some of them out of pocket since you see them infrequently?

  • Do you have a mental health provider? Some plans require that you meet your deductible before mental health is covered. Run the numbers – it may not make a difference if your mental health provider is covered or not.

 

Do you take any medications?

  • Are they generic drugs or brand name drugs? Some plans cover generic drugs immediately, but require you to meet your deductible before they cover brand name drugs.

  • If you have brand name drugs consider a Silver or Gold plan so you don't have to meet the deductible first.

  • What are the copays for the drugs?

  • What is the cash cost of the drugs?

  • Compare the premium of the different metal tiers with the prescription cost. A gold plan may have really good prescription coverage, but if you are taking only generic drugs, it may make sense to pay a little more for the prescription and save on the monthly premium.

 

How often do you see a doctor? Do you have any chronic conditions?

  • Do you prefer to pay a copay when you see the doctor?

  • If you have regular appointments, a copay plan may be easier to budget.

  • Your healthy college student may be more willing to go to the doctor if they know the cost in advance.

  • Copay plans tend to cost more and have a higher out of pocket limit.