Choosing a health insurance plan can be stressful. For one, you usually have a limited amount of time to make the decision. Plus, the selection process forces you to think ahead and consider what you and your family’s health needs will be for the next year, and that can feel a little bit like trying to predict the future.

To help alleviate some of that pressure, it can be helpful to start thinking early about the best health insurance plan for you and your family. August is a great time to reflect on what you like and what you don’t like about your current plan and imagine what your ideal health plan might look like, all while keeping your budget in mind. With a little time and research, you’ll feel better prepared to make a decision when enrollment opens later in the fall.  

Here are some questions to think about as you plan:

  1. Am I satisfied with my current plan?  If you had a plan in 2024 that covered the services and providers you needed at a price you can afford, that’s great news. Now you know to look for something similar when you enroll for your 2025 plan. On the other hand, if you’re not satisfied with your current plan, now is the time to make a list of the reasons why. Are they related to cost? Coverage? In-network providers? Customer service? The list you come up with can inform what you’re looking for in your next plan.
  2. Did I make the most of my current plan? Did you make a point of scheduling any preventive care, including check-ups, screenings and vaccinations covered by your health insurance plan? Did you address all of your health concerns? Did you look into the perks and benefits offered by your plan and use those? (If not, there’s still time to do so by the end of the year!)
    If you feel like you made the most of your plan, and/or you expect to have health concerns to contend with next year, you may want to maintain the same level of coverage or even increase the coverage according to your needs. In some cases, that may mean you’ll pay a higher premium, but the deductible and out-of-pocket costs might be lower. On the other hand, if you feel as though you rarely used your health insurance and you expect that next year will be similar, you may want to consider a plan that has lower premium costs, even if the out-of-pocket costs will be higher.
  3. Would I be better served by an HMO or a PPO? Before you even look at different plans, it’s helpful to know whether you want an HMO or a PPO. With an HMO, you choose a primary care physician (PCP) from within a network, and that doctor acts as the point person as you manage your health needs. That means that in order to see a specialist, for example, a person with an HMO must get a referral from their PCP. With a PPO, you don’t need a referral to make an appointment with another healthcare provider. In addition, if you have a PPO you can schedule appointments with providers and facilities outside of your network and still have those services covered by your insurance, although the costs may be higher than in-network. In a nutshell, HMOs tend to cost less, while PPOs tend to offer more flexibility and choice.
  4. Do I know what the different “metal” categories mean? Whether you’re going to be selecting a Medicare plan or a plan from the marketplace, you’ll notice there’s a metal theme going on. The four different categories — bronze, silver, gold and platinum — are based on how costs are shared between you and the health insurance plan. For example, according to Healthcare.gov, with a bronze plan the insurance company pays 60% of costs while the insured pays 40%; with silver, the split is 70/30; with gold it’s 80/20; with platinum it’s 90/10. The premium will vary accordingly, with bronze plans having the lowest monthly premium, but the highest costs when care is needed; whereas platinum plans will have the highest premiums but the lowest cost when care is needed.
  5. What is my budget for health insurance? When you’re deciding what plan to go with, the cost that tends to stand out the most is the premium, which is the amount you’ll pay every month (if you receive health insurance through an employer, the employer may pay a portion of the premium). And that is, indeed, an important cost to consider. But there are other numbers that are also important to weigh, as you think about how you’ll use your insurance. Those include:
    • Copay. The copay is the fee you pay for healthcare service, including doctor and hospital visits, and for medications.
    • Deductible. Your deductible is the amount that you will pay for covered health services before your health plan covers costs. If your deductible is $2,000, then that is the amount you will pay out of pocket. After you’ve paid your deductible, you’ll share costs with your plan. 
    • Coinsurance. Coinsurance refers to the portion you will pay for healthcare after meeting your deductible. Let’s say your coinsurance is 20%, and you receive a bill for $100. You’ll pay $20 and your insurance will pay the rest.
  1. Will I have any “qualifying life events” arising this year? For most people, the health insurance plan you choose when you enroll will be your plan for all of 2025. That is, unless you have what’s known as a “qualifying life event.” Then, you may be able to select a new plan during a special enrollment period. According to HealthCare.gov, there are four basic types of qualifying events: you lose your health coverage for a qualifying reason (for example, a job change, turning 26 or losing eligibility for Medicare, Medicaid or CHIP); you experience changes in your household (such as a marriage, divorce, death or arrival of a new child); you have a change in residence; or “other” events, such as a change in income that impacts the insurance you qualify for, becoming a U.S. citizen or getting out of jail or prison. If you anticipate having a qualifying life event, you can learn more here about what steps to take when the time is right.

Finding the right health insurance plan may take a little time and thought. But when you understand the costs and the coverage of the plan you choose, those efforts can pay off in the coming year, and empower you to take strides to feel your best.