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Ashley PoynterMar 126 min read

The best way to compare health insurance plans

Updated: Jun 25

Choosing the best health plan for you and your family can be a tall order. Often, you are going to have a limited time in which to choose the right plan, depending on whether you are enrolling during open enrollment or through a special enrollment period. The pressure is on; choosing the wrong health plan can add up to thousands of dollars in unnecessary expenses. Good news! You don’t have to freak out about going in blind. We’ve put together a few tips on how to compare health insurance plans and pick the right one.

Get to the right place

Your first step should be to visit the marketplace at HealthCare.gov. You’ll be prompted to enter your ZIP code. If your state has an exchange, you’ll be sent there, otherwise, you can browse plans on the federal marketplace. Shopping through these marketplaces opens you up to income-based discounts or premium tax credits on your monthly premiums.

Find the right type of plan

Navigating through the sea of letters can get confusing. Between HMOs, PPOs, EPOs and POS plans, it’s anybody’s guess as to what the best option is. Here’s what you need to know: each has its own set of pros and cons, so you’ll need to consider what is important to you. Take a look at our in-depth description of each type here to help you make the right decision for your unique circumstances.

Looking at the summary of benefits is a great place to start. The federal marketplace typically has a link to the summary near the cost of the plan. Be sure to reference the provider directory to ensure that any doctors or specialists you currently visit are covered under the plan. HMOs and POS plans require referrals, so keep that in mind when searching. Those will require you to see a primary care physician before you can schedule a procedure or see a specialist. If you prefer to have more control over which specialists you see, consider a PPO or an EPO.

Another option is to choose a high-deductible health plan (HDHP), which may fall into any one of the categories we mentioned above. These plans usually have much lower premiums but also follow strict rules that make them “HSA-eligible.” These plans also tend toward much higher out-of-pocket costs.

Consider the networks

“A health plan is only as strong as its network.” Ok, we just made that up, but it’s sort of true. Also true: costs are lower all-around when you visit an in-network doctor. You pay less, and your insurance company pays less because they have contracted lower rates with their in-network providers. Venturing outside of the network leaves you on the hook for the higher costs.

This is why it’s very important to have a list of all doctors, specialists and other providers that you wish to continue seeing. You should be sure they are a part of the provider directories for all plans that you are considering. It may be helpful to reach out to your doctor to see if they accept a specific health plan.

For those that don’t currently have a primary care doctor or another preferred physician, it can be beneficial to cast a wide net. Consider plans that have large networks so that you have a bigger pool to choose from. Consider your location and how many in-network doctors each plan has that are located nearby. You don’t want to have to factor in mega commutes every time you need to visit with your doctor.

Figure out your out-of-pocket costs

No one can predict the future or know ahead of time what health needs may arise in the upcoming year. That said, you can ballpark a pretty accurate number for you anticipated health care costs based on some known factors. It’s also important to understand health care jargon when comparing plans, including words that refer to the portion of costs you will have to cover: deductible, copayments and coinsurance. Check out our article here for more in-depth definitions of some keywords.

For the most part, the lower your premium, the higher your out-of-pocket costs. Figuring out which plan makes the most sense for you and your family can be a bit of a balancing act. On one hand, no one wants to get gouged paying ultra-high premiums each month; however, higher premiums where a higher portion of medical costs are covered may be the right play, particularly if:

  • You go to the doctor (either your primary care doctor or a specialist) often
  • You require high-cost medication on a regular basis
  • You will require surgery
  • You frequently require emergency care
  • You are planning to have a baby or are currently expecting
  • You manage a chronic health condition like cancer or diabetes
  • On the other hand, you may be interested in paying a lower monthly premium with higher out-of-pocket costs if:
  • You are young and healthy
  • You rarely visit the doctor
  • Your budget only enables you to pay lower monthly premiums

Determine which benefits are must-haves

At this stage in the game, you likely have narrowed down your options. It makes sense to evaluate which benefits you will absolutely need to have in making your final decision. Based on your current health needs, consider different buckets of care you want to be sure is covered under your plan. For example, do you need physical therapy, mental health care, fertility treatments, or other specific or ongoing needs?

While many of your questions about benefits should be covered in each plan’s summary of benefits, be sure to reach out to customer service if you have additional questions. It can be helpful to get added clarity from speaking to a real human on the phone.

Once you have established a shortlist of plans that cover all the care you will need for the upcoming year, you can begin to determine which factors are most important to you. In some cases, it may be as simple as basic addition and subtraction to find a plan that fits your budget. In other cases, you may need to determine what type of coverage works best for you and your family.

Consider a Decent Health Plan

Decent offers affordable, comprehensive health plans designed for freelancers, gig workers, and other self-employed individuals. As a result, we created our Pathfinder bronze plan, the Lonestar Bronze Plan and the Trailblazer silver plan. Our plans are ideal for self-employed individuals who want great coverage without breaking the bank:

  • Free primary care: see your doctor when you want, as often as you want ...for free
  • Open enrollment: enroll in one of our plans on your schedule, available 365 days a year
  • Affordable premiums: our rates run up to 50% below market, making them affordable for all

Interested? It's super easy to get started. Visit our website to get your free quote today.