What to consider when buying insurance?


Editorial team Published on

When choosing a health insurance plan, look at your total expected costs, provider networks, and prescription drug coverage instead of focusing only on the monthly premium.

You can compare options and check details directly through the Health Insurance Marketplace.

Key Costs

  • Premium: The set monthly payment you make to keep your insurance active, whether you use medical care or not.
  • Deductible: The amount of money you must pay out-of-pocket for medical care before your insurance starts paying.
  • Copays and Coinsurance: The fixed fees or percentages you pay for individual visits, tests, or procedures.
  • Out-of-Pocket Maximum: The highest amount you will pay in a year for covered services; once reached, the plan pays 100% of costs.

Provider Networks

  • In-Network vs. Out-of-Network: In-network doctors and hospitals cost less because they have contracts with your insurer.
  • Doctor and Hospital Availability: Check if your preferred primary care doctors, specialists, and nearby medical facilities accept the plan.
  • Plan Types (HMO, PPO, EPO): HMOs require in-network care and referrals; PPOs offer more freedom to see out-of-network doctors for a higher price.

Prescription Coverage

  • Formulary Lists: Confirm that your regular daily prescription medications are included on the plan's approved drug list.
  • Drug Tiers: Check how medications are categorized, as generic drugs cost significantly less than brand-name or specialty tiers.