Once you start shopping for a health insurance plan it’s easy to feel confused both by the variety of plans and the amount of information available. With so much to digest, it’s hard to know exactly how to choose health insurance. To make things easier we’ve boiled the process down to five essential questions.

Question 1: What type of plan is this?

You will likely be looking at lots of insurance plans. Most of them will be one of two types: a PPO (Preferred Provider Organization) plan or an HMO (Health Maintenance Organization) plan. PPO plans have a network of providers, usually called “in-network” providers. If you have a PPO and visit an in-network provider, you will pay less than if you visit a doctor that is out-of-network. You are free to choose any provider you like without a referral. HMO plans, on the other hand, typically require you to choose a primary care physician to coordinate all of your health care. HMOs require you to see only doctors that are part of the HMO, and you need a referral to see a specialist.

Question 2: Are my doctors, hospitals and drugs covered?

No matter what type of plan you choose, you’ll want access to the doctors and hospitals you prefer and the medications you need to take. Find out what doctors and hospitals are part of the plan’s network and check the plan’s formulary for drugs that are covered.

Question 3: What will my monthly premium cost and does that include a subsidy?

In considering how to choose health insurance, your budget is an important factor. A plan’s premium–the fixed amount paid each month for insurance–can be reduced by a government subsidy, so find out if you qualify. Although a low premium is better than a high one, you’ll need to consider all the costs associated with healthcare, not just premiums.

Question 4: What will my medical expenses be when I use health care services?

Sometimes your biggest health care expenses are the ones you incur when you go to the doctor.  One plan’s premium might be a few dollars more per month than another’s, but could save you a bundle when you go to the doctor–or not. Again, make sure you know all the costs associated with a plan, including the annual deductible, co-pays, co-insurance and the maximum out-of-pocket costs.

Question 5: What are the gaps in health insurance plans and can I do anything to fill them?

Health insurance won’t be able to cover every medical expense. You might need to travel regularly for specialized medical care or lose income while recovering from an illness. Fortunately there are inexpensive insurance products that can offset those kinds of expenses, so when thinking about how to choose health insurance keep in mind these gaps and seek help from a licensed health insurance agent to find a plan to help fill them.

HealthMarkets agents can provide the help you need and simplify health insurance shopping. With access to more than 200 different insurance companies who provide thousands of health plans nationwide, HealthMarkets can help find the right plan for your needs with the full subsidy you qualify for. Call us 24/7 at (800) 429-5058 or meet with one of our 3,000 local, licensed health insurance agents.


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