Choosing the right health plan can be a tough decision at any age, but it’s worth the time and thought you’ll put into it. As you research the plans available, it’s a good opportunity to also take stock of your health and consider any expected — and unexpected — health needs you think you might have in the coming year. To help you think things through, here are some questions to ask yourself during the selection process.

1. What important dates should I mark down?

  • If you’re signing up for a Medicare plan or a Medicare Advantage plan, there are specific dates to be aware of. If you’re new to Medicare, your initial enrollment period begins three months before you turn 65 and runs until three months after the month you turn 65. Or, you could sign up for coverage for the next calendar year during the open enrollment period. Check for those dates on Medicare.gov.  
  • If you’re purchasing a health insurance plan from the marketplace or from an insurance company, you’ll need to sign up during the open enrollment period. See those dates at Healthcare.gov.
  • If you’re on a health insurance plan through your employer, open enrollment could happen at different times; although January 1 is a frequent start date for new policies.

2. Are my expected health needs better served by an EPO or a PPO?

As you look over the different plans, you may need to decide between an EPO (Exclusive Provider Organization) and a PPO (Preferred Provider Organization). Here’s how each works: People who have EPOs receive coverage for providers who are in their provider network only, except in the event of an emergency. Whereas, people with PPOs have more flexibility to see providers who are out-of-network, although the costs  may be higher. So, while EPOs tend to cost less, PPOs tend to offer more choices.

3. What costs should I consider when choosing a healthcare plan?

There are a number of considerations to compare when deciding among different plans, and cost is always an important factor. Some of the costs to consider include:

  • Your premium. This is the amount you pay monthly for your health insurance. For some people who have an insurance plan through their employer, the employer may pay a portion of the premium.
  • Your copay. This is a set fee you pay for a healthcare service, such as a visit to a doctor or hospital, or for a prescribed medication.
  • Your coinsurance. This is the portion of the cost for healthcare that you will pay after you’ve met your deductible. For example, if you’ve met your deductible and your coinsurance is 20% and you receive a bill for $100, you’ll pay $20 and your insurance will pay the rest.
  • Your deductible. This is the amount you pay for eligible health services in a year before your insurance policy begins to share costs. If your deductible is $1,500, for example, you’ll pay for eligible costs for up to $1,500 before your policy helps pay for covered services.

4. Are my doctors in the plan’s network?

When a doctor is “in network,” it means that they have a contract through the health insurance plan to provide care to members at a negotiated rate. So the cost for using in-network providers is generally lower than those who are out-of-network. Before selecting a plan for yourself and your family, it’s important to check and see if your preferred healthcare providers are in-network.  

5. Will my medications be covered?

To make sure that any of the medicines you expect to take will be included in your coverage, check the plan’s formulary, which is the list of drugs the plan will cover (with Medicare this is called Part D).  

6. Will I be able to sign up for coverage outside of open enrollment?

When it comes to health insurance plans, there are a few life changes, known as “qualifying events,” that will enable you to sign up for coverage outside of open enrollment. Those include:

  • Losing health coverage
  • Moving
  • Getting married
  • Having a baby or adopting a child
  • Household income that falls below a certain amount

 

Still, many people will stay on their plan for the entire calendar year. That’s why it’s so important to put time and thought into comparing plans, reading the details on each and choosing the one that makes the most sense for you and your health needs.