How can you choose the right health insurance plan?

Michigan has one of the most robust health insurance markets in the country. We’re fortunate to have so many high-quality health insurance carriers to choose from, but the flip side means it can take time to find the plan that best fits your needs. No matter whether you’re shopping for individual coverage on the Marketplace, Medicare Advantage plans , or choosing a plan from your employer, there are a few key points you should consider.

1. Coverage:

The first and most critical factor is the extent of coverage offered by the health plan. You, or your insurance agent, should be able to answer the following questions:

•  How does the plan cover essential services like doctor visits, hospital stays, and prescription drugs?
• At what cost are specialist visits, maternity care, and preventive services covered?
• What can you expect to pay for emergency services and urgent care?
• What about mental health and substance abuse treatment?  

Ensure the benefits in the plan align with your specific healthcare needs and any potential future health concerns.

2. Network of Providers:

Take a close look at the plan's network of healthcare providers. Your choice of doctors, hospitals, and specialists may be limited to those within the plan's network. Here's what to consider:

• Are your current primary care doctors and specialists in the plan's network?
• Is the network broad enough to give you access to quality care, especially if you have specific medical conditions or require specialized care?
• Are you willing to switch healthcare providers if necessary to stay within the plan's network?

3. Cost:

Cost is a significant factor when choosing a health plan, and it goes beyond just the monthly premium. Consider these price points:

• Monthly premium: The amount you pay for coverage each month. Choose a premium that fits your budget.
• Deductible: The amount you must pay out of pocket before your insurance kicks in. A higher deductible usually means a lower monthly premium – but that also means you’ll need a plan to pay that deductible, should you need care that is subject to it.
• Copayments: These are flat-dollar fees you’ll pay each time you access care at a particular site, or for a specific service. Generally, copays apply both before and after the deductible is met.
• Coinsurance: This is the percentage of costs you'll share with your insurance for services like doctor visits and prescription drugs. Generally, coinsurance applies only after the deductible is met.
• Out-of-Pocket Maximum: The maximum amount you'll have to pay in a year for covered services. Once you reach this limit, your insurance should cover all qualifying expenses.

4. Prescription Drug Coverage:

If you take prescription medications regularly, ensure your drugs are covered at an affordable price. Check the plan's drug list to see if your medications are covered and at what cost. Nearly all plans have tiers for different medications, with varying copayments or coinsurance. What’s more, these tiers can vary from plan to plan.

5. Additional Benefits:

Many health plans offer additional benefits that can enhance your health and wellness. These may include:

• Wellness programs
• Telehealth services
• Maternity, newborn, and postpartum planning
• Dental and vision coverage
• Coverage for alternative therapies like acupuncture or chiropractic care

Evaluate these extras to determine if they align with your lifestyle and health needs.

6. Customer Support and Accessibility:

Consider the quality of customer service and the ease of accessing care with your chosen health plan. Factors to assess include:

• Is there a 24/7 helpline for medical advice or assistance?
• Can you easily access your plan's information and claims online?
•  Are there local offices or representatives you can reach out to for help?

7. Reviews and Reputation:

Research the health insurance company's reputation and customer reviews. Look for feedback from current policyholders to get a sense of their experiences with the company, especially when it comes to claim processing and customer service.

Make the right choice for you

Choosing the right health plan depends on your unique needs and values. By evaluating these criteria, you can make an informed choice that supports physical and financial health. Health insurance agents, are here to help you navigate this process and find the plan that’s right for you. Don't hesitate to reach out for guidance and support in securing the right health insurance coverage for you and your family.