5 Things to Consider When Choosing a Health Plan

By Sally Poblete, Founder and CEO, Wellthie

Open enrollment starts November 1 — will you be ready to shop for and purchase health insurance? There are many plan options being offered and the challenge comes in knowing what to look for to find the plan that is right for you. The 5 main areas to consider in your health plan selection are the premium, the level of benefits, out-of-pocket costs, your network of doctors and value added benefits.

The premium is the amount per month that you have to pay for getting coverage. Last year in the State of New York, this cost averaged $372 for a Silver plan. Silver represents the “metal level” of a health plan, which includes Bronze, Silver, Gold and Platinum. The premium differs by metal level, meaning that Bronze will have the lowest premium and Platinum will have the highest. The higher premium plans will pay for more of your medial services and drug costs when you receive services than those with a low premium.

You typically pay out-of-pocket costs when you use medical services, like a doctor’s appointment or a hospital admission. Each health plan has a maximum out-of-pocket limit that will tell you the most you will have to spend to cover services during the year. Your maximum out-of-pocket limit includes: your copays, the flat fee you pay in order to receive medical service; your coinsurance, what you pay in order to receive medical services as a percentage of its total cost; and your deductible, the amount you contribute before your insurance starts paying for your services. Remember; preventive care visits like annual checks-ups are covered at no charge!

An additional factor to consider when selecting a health plan is the network of doctors and hospitals you and/or your family will have access to. If you have an ongoing relationship with a doctor or a hospital, find out whether or not they will be a part of your new plan. Many health plans require that you pay for all or most of the cost of services if you visit an “out of network” doctor or hospital. To avoid this, always check with the doctor or hospital directly to make sure they are in-network with your insurance plan before you receive services.

Lastly, don’t forget that each plan may come with value added benefits. While all health plans cover the essential benefits — for example hospital stays, prescription drugs and access to mental health specialists — some health plans also provide video chat access to doctors, programs to help you stay healthy and many other services that are designed to support and encourage your lifestyle.

Although having a lot of choices in plans may seem daunting, it is important to be covered. The financial cost of not being covered in 2016 comes in the form of a tax penalty. The penalty will cost you the larger of 2.5 percent of your household income or $695 per person in 2016 and will continue to increase each year.

Click here to shop smart using EmblemHealth’s Affordable Care Advisor and see how you can afford the right health plan for you and your family. The Advisor helps you learn about products, compare costs and estimate financial assistance you may be eligible to receive.

Wellthie is a health care technology company offering software-based solutions that help simplify health insurance.