Reference below to 'expenses', 'coverage', 'treatment', or similar terms refers only to what is covered by the respective plan.
If you expect to get permanent coverage in the next 6 months (or 12 months in some states), e.g., from a new employer or from Medicare, you may want to look at short-term coverage. Otherwise, regular health insurance that will continue for as long as you pay the premium would be best. That is what is quoted here and described below.
Pick from these 4 broad categories:
1) Basic: A basic type of plan known as 'Hospital-Surgical' which covers only inpatient hospitalization and outpatient surgery. Other outpatient care is not covered, e.g., diagnostic testing, prescriptions, physician office visits, therapy. Outpatient cancer treatment and other expensive outpatient treatment may also not be covered. This type of plan will have the lowest premium because it has the least coverage.
2) Comprehensive: A plan with comprehensive coverage but you pay all expenses until an annual deductible is reached. You could choose a higher deductible to help keep the premium down but also have the assurance that no matter what happens, the treatment is covered if it becomes very expensive, inpatient or outpatient.
You may also be able to get a tax deduction for expenses paid before the deductible is met by using a health savings account.
3) Copays: A plan with copays for doctor office visits and prescriptions and perhaps certain other expenses also. It may be more generous than the other categories in covering preventative wellness checkups. Such a plan may, or may not, have an annual deductible and coinsurance for other expenses. The inclusion of copays will increase the premium so that for the same annual out-of-pocket exposure, this type of plan will cost the most.
The availability of such plans will vary a lot depending on where you live.
The Internal Revenue Code does not allow a health savings account for a plan with copays (except copays for preventive wellness checkups).
Both 2) and 3) may be called 'Major Medical' because they are more comprehensive than Hospital-Surgical. Any high deductible plan may be called 'catastrophic coverage'.
4) HMO: An HMO plan where care is coordinated through a primary care physician and specialists are available through referral by the primary care physician. This type of plan, if available in your area, will likely have the lowest copays, the lowest maximum out-of-pocket, and be most generous with preventative wellness checkups. In many areas, such plans are not available for individuals to buy.
Comparing
Since no one knows what the future will bring, the type of plan and the out-of-pocket limit chosen is a matter of personal preference. There is no 'best' plan for everyone. Optimistic expectations can be unexpectedly dashed. How health insurance has been 'used' in the past is no indication of how much or when it will be needed in the future. In order to know you would have to have significant pre-existing conditions and so need coverage by a government program anyhow.
You may want to pick the highest out-of-pocket that you are comfortable with in order to help keep the premium down. Any given hospital or medical provider may be happy to negotiate a payment plan to pay off a deductible/out-of-pocket amount if you at least have insurance to cover the bulk of a big medical bill.
Provider Membership
Keeping a special doctor or hospital: Because most plans, and the best priced plans, are PPO and HMO, it is most advantageous if any special medical provider is in the claims network of the insurance company. The 'Explain Health Insurance' link explains Indemnity, PPO and HMO in more detail.
Most doctors and hospitals join most PPO networks, but nothing is 100%. HMO membershp is less certain.
The network name and the insurance company name may be entirely different, so asking the doctor's office what 'insurance they accept' may be very misleading. The doctor's office sends the claim to the claims network office, not the insurance company, unless the insurance company operates its own claims network.
The quoting systems have a link called 'View Provider Network' or 'Doctors'. If you do not find your favorite doctors(s), please email or call us for assistance.
So What should You Buy?
Do you want to pay more per month in order to have copays? Most copays usually apply to the smaller expenses, so is it worth paying extra each month for that?
Do you want to pay less per month but pay 100% for all treatment until your chosen deductible is met?
What if you paid less per month and deposited the savings into an HSA? Now you keep the difference instead of giving it to the insurance company. Could you benefit from the tax deduction? If so, you are ahead on two counts. So pick a plan with "HSA" in the name.
Bear in mind that if you were to develop in the future a medical condition that required ongoing chronice expensive treatment, then every year thereafter you would have to pay the entire out-of-pocket amount of the plan that you have selected.
Is the lifetime maximum high enough for you? Do you feel comfortable with any special limitations in the plan? For example, some plans have a maximum annual limit on outpatient expenses. Remember, most copays usually apply to the smaller expenses anyhow, so are they worth paying extra for?
Are the limitations and exclusions okay with you? For example, some plans do not cover mental health or brand name prescriptions. Some plans may have a limitation on how much it will pay for specific conditions or treatments.
Make sure you use maximum reachable out-of-pocket amounts when comparing plans with each other. Coinsurance could be greater than the deductible, so reachable out-of-pocket is the benchmark to use, not the deductible.
Do you need to talk about it? If so, give us a call.