How to Find the Right Health Insurance for You

Choosing the right health insurance plan could be a huge challenge if you are self-employed or running your own small business. It's not that there is a lack of good insurance companies. Hundreds of insurance companies nowadays offer cost-effective, affordable plans; that's why, it has become an incredibly tough task to find the best deal.

So how may you find the right health plan that is cost-effective and covers all your needs? Let's find out!

1. Get Yourself Familiarize with The Basic Terms of a Health Plan

If you already have a good understanding about health insurance, you may skip this section. But I think it's always a good approach to reread and try memorizing the common terms before moving forward.

picture of a health plan finder

What is a Health Insurance?

Health insurance is usually an agreement or a somewhat well documented contract between you and the insurer. Within this contract, the insurer will be circumscribed to share a portion of your medical expenses when you get injured or sick and admitted in a hospital or clinic. However, the certain amount the insurance company will pay on your behalf depends on several factors including the insurance policy, coverage, and financial plan.

Insurance Policy, also called as the contract, is the legal agreement that determines the amount, which the insurer is legally bounded to pay under what circumstances.

Premiums are the agreed amount in the contract that you need to pay on a monthly basis to get the coverage of your health plan.

Deductible (a very familiar term related to insurance) is the certain amount that you need to pay the insurer to uncover the coverage of the health plan.

Co-payment, also known as copay, is another important term related to health insurance. Usually, a co-payment is a specific amount agreed within the contract that you would need to pay for medical services you receive before you reach your deductible.

Coinsurance is the certain percentage of the health care provider’s charge (usually 20% of the provider’s bill) that you would need to pay after you reach your deductible. Under the coinsurance plan, you would need to pay the agreed percentage until you reach the out-of-pocket maximum. However, you need to know that people often confuse coinsurance with co-payment due to similarity, but they are totally two different terms with two different meaning.

Out-of-pocket expenses are non-reimbursable expenses that you would pay for medical services beyond your monthly insurance premiums. In simple words, if the required health care services are out of your health plan’s coverage, you need to pay for the expenses and in terms of policy, these expenses are literally known as out-of-pocket expenses. Coinsurance, co-payment, and annual deductible for the insurance coverage may also consider as out-of-pocket expenses until your health plan benefits uncover 100% coverage.

Out-of-pocket maximum is the certain amount agreed in the insurance contract that must be paid out of your pocket, usually up to an annual or lifetime maximum, before you unlock 100% of the health plan’s benefit.

Lifetime maximum is the maximum amount the insurer will pay on your behalf during the life of the policy. However, you need to know that the definition of lifetime maximum may vary depending on the health plan you choose. Some health plan may define lifetime maximum as the maximum amount the insurer will pay during your lifetime.

2. Visit your marketplace

To compare the available plans and prices in your area, go to HealthCare.gov and enter your ZIP code. If the map highlights your state in green, you’ll be directed to your state's exchange. But if it is in blue, you’ll be needed to choose the plan using the federal marketplace. You may also use the quick screener to see whether you qualify.

HealthCare.gov health insurance plans & prices

3. Find Out What Your Desired Coverage Is

Don’t play blind while choosing your health plan, because the well-being of your whole family depends on you. If you're able to choose the right plan for you and your family, it could turn out to be the best decision you've ever taken in your lifetime. So before purchasing a health plan, ask yourself about the kind of health insurance you need and how much you really can afford.

Where should you focus about health insurance

For your help, below is a list of questions that may help you to realistically understand your needs. Careful consideration of these questions will help you to make the right decision while choosing a plan.
  • Do you want to get married?
  • Do you have any dependents?
  • Are you planning to have a baby?
  • Are you prior to retiring?
  • Are you having any pre-existing conditions?
  • Are you often got sick with common cold or seasonal flu?
  • Do you often buy prescription drugs?
  • Do you know about the 2010 Affordable Care Act legislation?
  • Are you just thinking to have a safety plan only to safeguard you or your family members in case of something catastrophic?
  • Did you think about preventive care? If so, how much you expect from the health plan.
  • How comprehensive do you need your health insurance to be?
  • Do you have any preference about doctors and hospitals or clinics?
  • Do you know how the policy of a health insurance works?
Also, you need to be ready to make adjustments with your desires. It would be near impossible to find the one perfect deal that covers all your needs. Because the needs of you and the needs of others vary greatly, there is no one-size-fits-all type health plan. However, don’t feel that you are out-of-the-way. Health insurers usually tailor their offers keeping in mind the different consumer requirements.

To know more about different options of health plans with details, read my post Health Insurance Plan Options – Managed Care vs. Fee-for-Service Plans.

4. Know Your Limits

Making a balance between your affordability and needs is the single most important thing that you need to do before choosing your health plan. If you are running under a low financial ceiling, accept the fact that you may not be able to get the desired coverage you would like to have.

Be realistic and practical. Ask yourself the following financial questions to evaluate whether you really can go with your needs.
  • Can you really afford the monthly premium?
  • How often you visit your GP?
  • How much money you spend on medical bills in a year?
  • How much money you spend on prescription drugs (both monthly and annually)?
  • Do you really believe you can meet the deductible and unlock the full coverage?

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