Important questions to ask when buying health insurance

Health care jargon explained
Health insurance 101

Buying health insurance is one of the biggest investments you can make. Not only are you investing in services, but you are investing in your health. Whether you’re searching for the perfect plan solo or employing the help of a health insurance broker, we’ve compiled some key questions you’ll want to keep top-of-mind as you browse options.

Which type of plan makes sense for me?

Health plans are organized by metal tier, with bronze plans typically having the lowest premiums and platinum plans having the highest. Be sure to look beyond the premiums, however, and consider other important factors when making your decision.

Everyone has different needs, so it’s important to understand and anticipate your unique health needs when buying health insurance. Some people prefer to purchase just enough coverage to be covered in case of an emergency. Others may have medical issues that require surgery or other significant tests. It makes sense to map out your individual situation and account for any upcoming services you might need.

How much does health insurance cost?

Great question! It’s also a complicated question. While it’s impossible to be an oracle regarding health needs, you can make some educated guesses about what you might expect. Using that information, you can look at three important factors to help you arrive at an estimate for health care costs: deductible, out-of-pocket max, and premium. Each of these will impact the total amount you spend on health care costs each year.


The deductible is the amount you pay before the insurance kicks in to cover additional care. So, if your deductible is $2,000, that is the amount you’re responsible to pay before the health insurance plan begins to pay out. The thing to remember is that having insurance means you pay a negotiated rate on health care costs, which can be much lower than you would pay without any insurance at all.

Out-of-pocket max

This is an area where people often get confused, so we’ll illustrate with an example. Let’s say you require surgery, and the costs total $25,000. Let’s also assume that your plan looks like this:

Deductible: $5,000Coinsurance: 20%Out-of-pocket max: $8,000

Great news: you will not be responsible to pay the entire $25,000 for surgery. Instead, your responsibility will look like this:

Deductible: You pay the first $5,000 of covered medical expenses.

Coinsurance: You pay 20% coinsurance on the rest of the costs ($20,000), which amounts to $4,000.

At this point, it looks like your total costs would be $9,000 (this is the total of your deductible and coinsurance or $5,000 + $4,000).

But wait! Your out-of-pocket maximum is $8,000, so your insurance company will pay all covered costs that exceed that amount. That includes this hypothetical surgery as well as any other covered care you need for the rest of the plan year.


This one is the easiest to calculate. If you buy a health insurance plan that has a $250 premium, your total annual premium costs will be $250 X 12 = $3,000.

What is direct primary care (DPC) and why does it matter to me?

Direct Primary Care (DPC) is a movement where many primary care providers are now offering plans to provide individuals and their families with unlimited access to a doctor for a flat, monthly fee. It replaces the fee-for-service model with a value-based alternative that centers on the doctor-patient relationship.

It also serves to improve healthcare quality and access by cutting out unnecessary paperwork and costs. It eliminates the need for doctors to deal with claims and insurance companies and the accompanying paperwork and allows them to focus on excellent patient care instead.

The DPC model is a paradigm shift in healthcare that incentivizes your doctor to keep you healthy. Since you pay a flat monthly fee, doctors want to ensure you get the best care possible because their costs increase when you need additional care. DPC creates the common goal of high-value care that keeps your health—and doctors’ costs—in check.

Who is Decent and why should I pay attention?

Decent is solving healthcare for the self-employed. We offer a Pathfinder bronze plan and a Trailblazer silver plan, both of which are designed to fit your needs. Whether you’re looking for lower monthly premiums or more comprehensive coverage, we have something for you. Our plans place no restrictions on pre-existing conditions (or charge extra) and you don’t need to undergo a medical screening to qualify. We believe this is how healthcare should be.

We also offer free primary care as part of all our health insurance plans, so you don’t have to worry about any fees at all. The DPC’s flat fee is included in your monthly premium — so you don’t need to pay twice. You also get access to high quality, affordable, and coordinated specialty care options at transparent rates (read: no hidden fees) for anything that can’t be handled in the primary care setting. This means you have unlimited visits with your primary care doctor every month - for free. That’s right, free. No copays, no mystery bills showing up in your mailbox weeks later. Free.Contact us today to get your free quote.

Welcome to Decent: a new kind of health plan.

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