Confused by Health Insurance Plans?

Four ways to pick the right plan and get the best value for your money

You’ve probably been making a health insurance choice for years. But are you really making a decision based on your family’s needs? Are you sure that you’re getting the most for your money? Below are some tips to help you choose a plan that won’t waste your money, but provide the right amount of coverage for your family. To choose the plan that’s best for your family for 2023, consider how you’re using your current plan.

What you should consider

The true cost of health insurance involves more than just your monthly premiums. It also involves how much and what type of healthcare services your family uses.

1. Estimate next year’s healthcare needs. This can be tricky, so look at what you’ve spent for 2022. Think of any changes (like starting a family) that may affect your healthcare spending. To get an estimate, add together:

• Primary care physician and specialist office visits.
• Prescription drugs.
• Upcoming planned surgeries and/or hospitalizations.

2. Understand your deductible. The deductible is the amount you pay out of your pocket before your plan’s coinsurance starts paying. Lower-deductible plans look attractive, but have higher premiums. And because routine care like doctor’s visits are covered by a copay and don’t require you to meet your deductible, many healthy people don’t meet it. To determine the appropriate deductible, consider:

• Will you have a procedure that would apply to the deductible?
• How much would you save on your monthly premiums by moving to a higher-deductible plan?
• Could you set aside savings from your monthly premium to pay for the higher deductible?

3. Consider your coinsurance. Coinsurance is the amount your plan plays for services once you’ve met your deductible. Your costs can be higher if you use an out-of-network provider.

• Can you meet your family’s medical needs using in-network providers?
• If you meet your deductible and need more care, how much will coinsurance cost you?

4. Determine the annual cost of coverage. To determine a plan’s annual cost (the cost to have the plan, not use it) multiply the monthly rate by 12. Setting aside money to meet a higher deductible will allow you to choose a lower-cost plan. This means you would pay less per month but still be protected.

Put it all together

To consider the total cost of the plans, add up:

• Your copays for office visits.
• The plan’s deductible (if you think you will meet it).
• Your coinsurance (if you meet the deductible).
• Estimated costs of prescriptions.
• The insurance premium for that plan.

Most PPO plans have a maximum out-of-pocket amount. This doesn’t include office visit copays or prescriptions drugs, but is a good indicator of where your financial responsibility will end.