Deciding which health plan is right for you depends on many factors, including your family situation, age, current health, anticipated health care needs and available plan options.
It's a good idea to assess your needs and identify your priorities so you know what to look for in a plan.
Assess your needs
Consider a few questions to help predict what medical services you'll need in the next year. For example:
- Does anyone who will be covered by the plan see a specialist for a chronic condition?
- Do you or your family members take any prescriptions regularly?
- Do you need additional coverage for vision or dental care?
- Is anyone in your family planning a pregnancy?
Estimate costs
Given your health care needs and priorities, estimate how much you'll pay during the year under each of your plan choices. Be sure to include premiums, copays, prescription costs and other products and services (like eye exams and eyeglasses) in your assessment.
Identify priorities
Rate the importance of health plan features and factors in light of your family's needs. Features and factors to consider include:
| Copay amounts |
Some plans require copayments for any physician or other healthcare office visit. Others cover preventive care 100 percent but leave paying for some visits, such as those due to illness, to you. |
| Monthly premium |
Lower monthly premiums can save you money. They also mean you may have to pay a higher amount toward your care before the health plan contributes. Higher premiums may provide more coverage with no extra payment, such as a copay. |
| Annual deductible |
This is the amount you need to pay before your health insurance contributes to your costs. Higher deductibles generally lower your monthly premiums. Consider how much you can afford to pay out of your own pocket or from a health account, such as a flexible spending account (FSA) or health savings account (HSA), if your healthcare expenses suddenly rise. |
| Preventive services |
Annual checkups and routine screenings, such as breast mammograms and cancer screenings, are key to staying healthy and lowering your overall medical costs. Check to see which services are covered and how much you'll pay. |
| Health account options |
Plans with certain limits on your annual deductible and out-of-pocket expenses can qualify you to open and save in a health savings account (HSA). Your employer may offer an HSA-qualifying plan, or you may buy one yourself.
If you receive insurance through your employer, also check to see if you have a health reimbursement account (HRA) or the option to open a flexible spending account (FSA) to help reduce your out-of-pocket costs and, with an FSA, your income taxes. |
| Provider network |
Some plans restrict your choice in doctors and facilities to those in their network of healthcare providers. Others let you go “out-of-network” for care, but they may not cover the costs at the same level. Find out what the plan's requirements are and check to see if your doctors are in the network.
You can also check to see if the plans you're considering rate doctors and facilities for the quality and value of their care. |
Health savings accounts are offered by OptumHealth Bank, Member FDIC, and are subject to eligibility. This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state regulations are subject to change. Please check your health benefit plan materials to determine whether your employer will make supplemental contributions to your HSA.
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Health care plans generally fall into two categories — fee-for-service and managed care: 