Great question! The answer can be found by asking yourself a few simple questions. The first is how healthy am I? do I visit the Doctor only for the occasional check up, or do I have an issue that requires more frequent visits? If you rarely need the doctor, then maybe a plan with a higher deductible, and co-pays is a cheaper and better plan. If you have more frequent needs, then look for a plan that has lower co-pays and deductibles. When the www.heathcare.gov site becomes available for enrolment again, try there, and see if you qualify for help with your plan payments. If you need help, please feel free to contact me, okay? Thanks for asking!
Assuming you are talking about individual major medical insurance purchased after January 1, 2014, I think it comes down to some basic questions such as;
1) Do I qualify for a subsidy of my health insurance if I purchase it through the government health insurance marketplace? The answer to this question may help you determine if you wish to purchase your coverage inside or outside of the government marketplace. In many areas of the country you will have more insurance carrier options outside of the government marketplace.
2) Affordability - with or without a subsidy, what does your personal budget allow you to spend on health insurance premiums each month?
3) Plan Design & Cost Sharing - you will see a bewildering array of plan designs, many of which will look quite different from what you may have seen in the past. Terms such as Bronze, Silver, Gold & Platinum will need to mean something to you as they denote some basic levels of coverage and what you might anticipate in paying out of your pocket before your insurance benefits begin to pay. Bronze plans will offer the lowest monthly premiums but they will almost universally require you to pay a substantial deductible (perhaps $6000+) before anything other than preventive care is covered. The trade off for a lower monthly premium can be more than offset by paying out of pocket for doctor's services, inpatient & outpatient services and prescriptions. You will have to make some judgment call as to what you anticipate your health care consumption will be and how much up front financial exposure you are willing to take. If you are dealing with a chronic medical condition like diabetes you may be better served to pay a higher monthly premium for higher level plan designs that offer copays and lower deductibles.
4) Provider Network - are the doctors, hospitals and pharmacies you want to use in the provider network for the insurance plan you may be interested in? This is an especially sensitive area to women and one where you really need to do your homework. If you are purchasing coverage outside of the government health insurance marketplace you can be pretty confident that the providers the carrier says are in-network really are. There has been no small amount of confusion on this issue with some of the insurance plans offered in the government health insurance marketplaces. Also, you are more likely to encounter "skinny" networks in the government marketplaces than outside of them. The insurance products using skinny networks will generally be among the most attractively priced but the trade off is a significantly reduced provider network and possibly an environment more centered around Physician Assistants and/or Nurse Practitioners.
5) Prescription Formulary - this kind of goes along with the points I was making above but it deserves special attention. You should not assume that every insurance carrier or even every insurance plan option offered by the same insurance carrier will cover the specific prescription medications you use. Every carrier uses prescription formularies (lists of approved drugs) and they can vary widely in what they cover, at what level they cover it, and possibly what steps you may have to go through before a specific medication would be approved for coverage. If you are using specific prescriptions you would be wise to verify their coverage status with a potential carrier before you enroll with them.
6) Does Your Coverage Extend Beyond Your Local Area & Does it Require a Primary Care Physician Referral in Order to Visit a Specialist? - some plan options may be restrictive as to the geographic boundaries of your coverage and may provide little or no coverage outside of their "service' area. If you are the stay at home type this may not be an issue for you but if you travel a lot is may be a serious factor in your decision. Also, you should not assume that you can just go directly to any specialist (even if they are in-network) without a referral from your Primary Care Physician (PCP) first. Some plans require a referral from a PCP to access specialty care. Without such a referral in these plans you may find your claim denied or treated as an out-of-network claim. You need to determine if the health plan you are considering uses such a gatekeeper approach and decide if this is acceptable to you.
If you can do all these things then you will be well positioned to find a health insurance plan that best fits your needs. If you feel you are not equipped to find the answers to all these questions on your own then you should seek out an independent insurance broker to guide you through this process.
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1) Do I qualify for a subsidy of my health insurance if I purchase it through the government health insurance marketplace? The answer to this question may help you determine if you wish to purchase your coverage inside or outside of the government marketplace. In many areas of the country you will have more insurance carrier options outside of the government marketplace.
2) Affordability - with or without a subsidy, what does your personal budget allow you to spend on health insurance premiums each month?
3) Plan Design & Cost Sharing - you will see a bewildering array of plan designs, many of which will look quite different from what you may have seen in the past. Terms such as Bronze, Silver, Gold & Platinum will need to mean something to you as they denote some basic levels of coverage and what you might anticipate in paying out of your pocket before your insurance benefits begin to pay. Bronze plans will offer the lowest monthly premiums but they will almost universally require you to pay a substantial deductible (perhaps $6000+) before anything other than preventive care is covered. The trade off for a lower monthly premium can be more than offset by paying out of pocket for doctor's services, inpatient & outpatient services and prescriptions. You will have to make some judgment call as to what you anticipate your health care consumption will be and how much up front financial exposure you are willing to take. If you are dealing with a chronic medical condition like diabetes you may be better served to pay a higher monthly premium for higher level plan designs that offer copays and lower deductibles.
4) Provider Network - are the doctors, hospitals and pharmacies you want to use in the provider network for the insurance plan you may be interested in? This is an especially sensitive area to women and one where you really need to do your homework. If you are purchasing coverage outside of the government health insurance marketplace you can be pretty confident that the providers the carrier says are in-network really are. There has been no small amount of confusion on this issue with some of the insurance plans offered in the government health insurance marketplaces. Also, you are more likely to encounter "skinny" networks in the government marketplaces than outside of them. The insurance products using skinny networks will generally be among the most attractively priced but the trade off is a significantly reduced provider network and possibly an environment more centered around Physician Assistants and/or Nurse Practitioners.
5) Prescription Formulary - this kind of goes along with the points I was making above but it deserves special attention. You should not assume that every insurance carrier or even every insurance plan option offered by the same insurance carrier will cover the specific prescription medications you use. Every carrier uses prescription formularies (lists of approved drugs) and they can vary widely in what they cover, at what level they cover it, and possibly what steps you may have to go through before a specific medication would be approved for coverage. If you are using specific prescriptions you would be wise to verify their coverage status with a potential carrier before you enroll with them.
6) Does Your Coverage Extend Beyond Your Local Area & Does it Require a Primary Care Physician Referral in Order to Visit a Specialist? - some plan options may be restrictive as to the geographic boundaries of your coverage and may provide little or no coverage outside of their "service' area. If you are the stay at home type this may not be an issue for you but if you travel a lot is may be a serious factor in your decision. Also, you should not assume that you can just go directly to any specialist (even if they are in-network) without a referral from your Primary Care Physician (PCP) first. Some plans require a referral from a PCP to access specialty care. Without such a referral in these plans you may find your claim denied or treated as an out-of-network claim. You need to determine if the health plan you are considering uses such a gatekeeper approach and decide if this is acceptable to you.
If you can do all these things then you will be well positioned to find a health insurance plan that best fits your needs. If you feel you are not equipped to find the answers to all these questions on your own then you should seek out an independent insurance broker to guide you through this process.