How to Compare Health Insurance

A woman is using her computer at home.
Image Credit: Marili Forastieri/Photodisc/Getty Images

Whether you purchase your own health insurance or receive it through your workplace, you probably have more than one plan to consider. Choosing a health insurance plan involves comparing the details of standard aspects of the plans, like out-of-pocket costs and coverage limits, with how much you want to spend on the premiums . Consider the ways in which you need health insurance to work for you, such as special programs for chronic disease management or rewards for participation in education programs,

Comparison Resources

If you are buying a plan through your job, your employer can provide you with a summary plan description. Health insurance companies often provide online resources for comparing the plans available. For Healthcare Marketplace plans, the website allows you to select different plans and coverage levels for comparison. The Medicare website offers a similar service for comparing private supplemental plans. The National Committee for Quality Assurance, or NCQA, publishes its Health Insurance Plan Rankings in partnership with Consumer Reports. Visit the Consumer Reports or NCQA website to check the rankings of plans you are comparing.

Providers and Formularies

If you have a personal physician you like and trust, or if you regularly take prescription medications, look at the provider networks and drug formularies of the health insurance plans. Some plans prefer members to choose health care providers from within its network and will pay less for services from an out-of-network provider. Check the plan's drug formulary, which is a list of medications covered under the plan. Some health insurance plans provide a method for members to make special requests for providers or medications not usually covered.

Premiums and Deductibles

Compare the amounts you will pay for premiums and deductibles. The premium is the monthly payment you make for your health insurance. The deductible is the amount you must pay, excluding the premium, before the plan begins to pay some of the costs. Compare the way deductibles work for families. Some plans offer embedded deductibles that allow a member of a covered family to meet his deductible separately, while others require payment of the entire deductible before the plan pays for any of the family's care. Find out if the prescription plan is tied to the deductible and look for separate deductibles required for certain medical services, such as hospital care.

Cost-sharing Options

Compare your potential out-of-pocket costs for copayments or coinsurance, which are cost-sharing options requiring you to pay some portion of your medical bills even after the deductible is met. The copayment is a set amount you pay for certain health care services. For instance, you might pay a $25 copayment for a doctor's office visit. If a plan requires coinsurance, you pay a percentage of each bill and the plan pays the balance. The percentage split might differ based on the type of service. Compare each plan's out-of-pocket maximum, which is the most you will pay towards your health care in the enrollment year before the plan pays 100% of allowable costs.

Health Insurance Changes

Changes made to health insurance plans by the Affordable Care Act, or ACA, remove some of the work of comparing the plans. The ACA prescribes the essential services that most health insurance plans must cover and establishes the maximum out-of-pocket limit for individuals and families. The ACA requires health insurance plans to provide free preventive care, such as annual check-ups, which is not tied to the deductible. Plans cannot deny coverage to children based on pre-existing conditions

references & resources