What do you need to know to choose the best health plan for you? You’ll want to look at the costs and coverage to find the right balance for you and your family.
Look at the costs
When shopping for a health plan, you might look closely at the monthly premium and how this fits into your budget. But don’t forget to review the costs that you’ll pay for health care throughout the year. You want a health plan that fits your budget and provides the right level of coverage.
The two basic types of costs you pay with a health plan are:
- Monthly premium. The amount you pay for the health plan every month. Tip: If you qualify for a premium subsidy, you may have a reduced monthly cost.
- Out-of-pocket costs. The costs you pay when you use health services. Tip: New Mexico residents, including Native Americans, may qualify for health plans with reduced costs or no costs for health care. Out-of-pocket costs include:
- Annual deductible amount — the cost you pay before the health insurance starts to help pay for your health care costs
- Copays — payments you make at the time when you receive health services
- Coinsurance — a percentage you pay, usually a bill that comes later
Consider your health care needs
Should you consider a high-deductible health plan or a traditional plan with a lower deductible? It depends on how you want to pay for your health care and how much you use health services.
Higher deductible, lower premium
Are you and your family healthy with few, if any, health issues? Do you rarely visit the doctor? Of course it’s possible to experience an injury or illness anytime, even if you’re in good health. (That’s why you should get covered.
) But you may decide that it’s worth it to select a health plan with a low monthly premium, even if you have to pay more for health services when you need them.
Lower deductible, higher premium
Do you or your family members visit the doctor often? Do you need help managing a chronic illness? Do you take a lot of prescription medications? Do you expect to have surgery or other major changes in your health in the next year? If you need a lot of health services, you may want to choose a plan with a low deductible so more of your out-of-pocket costs
are covered. You may also want to consider choosing a plan that has a lower annual out-of-pocket limit so you can be protected from very high costs.
How to decide what’s right for you? Learn more about bronze, silver, gold and platinum metal level plans.
Check the doctors in the network
A health plan network is the group of doctors and facilities that has a contract with the health plan to provide health care services. Check to see if your doctors are included in a health plan’s network before enrolling in the plan. Find out how in-network and out-of-network care
may affect the costs you pay.
Find out what’s covered
Every health plan includes a basic set of essential health benefits
. These essential benefits include doctor visits, hospital stays, maternity care, emergency room care, prescriptions and more. Some plans have additional coverage for other health services. Check the plan details for a list of covered services.