6 Smart Strategies for Choosing a Health Plan

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A husband and wife sit together with a laptop and paperwork to compare personal health plans.

Choosing a health plan can sometimes feel overwhelming. Is a high deductible right for me? Which plan will cover my prescriptions? Am I free to see any health care provider? These are a few questions that may come to mind as you navigate plan options.

How to Choose the Right Health Plan

There’s no one-size-fits-all health plan for everyone. That’s why we’ve developed six smart strategies to help you choose a health plan that balances affordability with your health needs and stage of life.

1. Evaluate What Matters Most

As you consider your plan options, weigh the following factors:

  • Enrollment: Find out when you qualify for enrollment. This could be during open enrollment (usually begins in November) or when you start a job , lose coverage, or experience a qualifying life event such as marriage. For GuideStone® plans, review Personal Plans eligibility and enrollment guidelines.
  •  Cost and coverage: Do the plan’s costs fit into your budget and cover your health needs? (We’ll explore this in detail below.)
  • Reputation: While cost is an important factor, don’t decide by that alone. Consider the company’s strength and reputation also. You can research complaints here.*
  • Medical networks: Do you already have an established relationship with a health care provider? Find out which providers and facilities are considered in-network and learn how out-of-network costs are calculated.
  • Prescription medications: Learn how coverage works if you anticipate needing prescription drugs. Do costs apply to the deductible? Or are prescriptions covered with co-pays? Is your pharmacy of choice considered in-network?
  • Mental health: Does the plan cover mental health services?
  • Values: Does the plan align with your values? For example, GuideStone offers church plans designed with biblical values in mind.
2. Estimate Next Year’s Health Care Costs

Look at what you spent last year, including doctor’s visits, medications, procedures, surgeries, hospitalizations and medical equipment expenses. Then, consider any changes that you foresee in the following year. Do you plan to start a family? Will you soon be an empty nester? Do you anticipate needing a costly medical procedure? Will you begin a maintenance medication?

The actual cost of health coverage involves how much and what type of health care services you and your family use. Calculate the following:

TABLE A Last Year's Actual Costs Upcoming Year's Estimated Costs
Primary care physician and specialist office visits $ $
Prescription medications $ $
Surgeries and hospitalizations $ $
Other (medical equipment, procedures, therapy, etc.) $ $
TOTAL $ $ **Use this amount below in Table C to estimate your overall plan costs.
3. Understand Your Deductible

The deductible is the amount you pay out-of-pocket before your plan’s co-insurance kicks in. The lower the deductible, the more the health plan typically costs.

A scale illustrates a lower deductible on the lower end of the scale, and a higher deductible on the higher end of the scale. 

If you rarely meet your medical plan’s deductible, consider selecting a higher-deductible plan. The monthly cost will be lower, and you won’t pay for coverage you may not need.

To determine the deductible that best fits your needs, ask yourself:

  • Will I likely have a procedure that would apply to the deductible?
  • How much would I save on monthly costs by moving to a higher-deductible plan?
  • Could I set aside savings from my monthly cost to pay for the higher deductible?
4. Consider Your Co-insurance

The co-insurance is the amount your plan pays for eligible services after you meet your deductible. For example, a plan may have 80%/20% co-insurance. This means that after your deductible is met, the plan will pay 80%, and you’ll pay 20% of future costs. (Plans have a maximum out-of-pocket amount that limits how much you can spend on in-network eligible medical expenses in a year.)

If you don’t usually meet your annual deductible, the co-insurance is a less critical factor. If you do usually meet your yearly deductible, consider your estimated portion of the co-insurance.

A step-by-step graph illustrates the progression of cost responsibility between the health plan member and the health plan.

5. Calculate the Annual Cost of Coverage

To determine a plan’s annual cost, multiply the monthly rate by 12. But remember, this is the cost of having the plan, not using it. You’ll pay this fixed amount each month regardless of whether you’ve used health care services.

6. Put It All Together

Now, determine the total cost of the plan you’re considering.

Deductible + Co-insurance + Annual Cost of Coverage = Total Cost

Here are a few examples to illustrate how the plan components and individual health needs can impact the plan’s total cost.


TABLE B
Plan Details Total Out-of-Pocket Costs
Example 1: Peter is generally healthy and spent $250 on doctor visits for the year.
Plan A:
$5,000 deductible
80%/20% co-insurance
$432 monthly cost
$250 toward deductible
+ 0 co-insurance
+ 5,184 cost across 12 months
$5,434 Total Annual Cost
Plan B:
$1,000 deductible
80%/20% co-insurance
$734 monthly cost
$250 toward deductible
+ 0 co-insurance
+8,808 cost across 12 months
$9,058 Total Annual Cost 
Example 2: Paul saw specialists, took several prescription medications and had a major medical procedure for a total of $26,000 for the year.
Plan A:
$5,000 deductible
80%/20% co-insurance
$432 monthly cost
$5,000 toward deductible
+ 4,200 co-insurance (20% of remaining $21,000)
+ 5,184 cost across 12 months
$14,384 Total Annual Cost
Plan B:
$1,000 deductible
80%/20% co-insurance
$734 monthly cost
$ 1,000 toward deductible
+ 5,000 co-insurance (20% of remaining $25,000)
+8,808 cost across 12 months
$14,808 Total Annual Cost


Now, estimate and compare the costs for the plans you’re considering.

TABLE C
Compare and Estimate Your Costs
Last Year's Plan $ actual amount you paid toward your deductible
+ actual co-insurance expenses
+ cost across 12 months
$ Total Annual Cost
New Plan
Deductible $
Co-insurance %/ %
Monthly cost $
$ **estimated total from Table A, up to the deductible amount
+ estimated total from Table A over the deductible amount, multiplied by the co-insurance %
+ estimated monthly cost across 12 months
$ Total Annual Cost
Minimize Health Care Costs After Plan Selection

If you select a high deductible plan with a lower monthly cost, consider adding the monthly savings into a Health Savings Account (HSA). This is a tax-free way to set aside money for unexpected medical expenses. Funds in an HSA roll over annually, so you’re not at risk of losing the money if you don’t use it. Learn more about the advantages of an HSA account and find more ways to save on health care expenses.

Get More Help Understanding Your Health Plan Options

Choosing a health plan can be challenging, so we’re here to help. If you’re considering a GuideStone health plan, call us to walk through your options together. You can also follow our health plan decision guide to identify which plan may best fit your health needs and budget. For more information, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.


GuideStone welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as legal advice, tax advice, or medical advice, diagnosis or treatment.

*Content.NAIC.org/cis_consumer_information.htm