Healthcare Business DEMYSTIFIED

de mys ti fy - to make less mysterious, clarify

How do I choose the best insurance option for me and my family?

You want to be able to choose the best insurance plan for you and your family but also keep the monthly premium affordable.  If you can get insurance at the place that you work, you will most likely find that it is your most affordable option.  Many employers will pay a portion of the monthly premium and that alone will decrease your monthly expense.  If you do not have healthcare benefits at work, or you are self-employed, you will need to buy insurance on the open market.  A website, like, can let you see what options are available to you in your area.  It is also a good idea to look at for the options being offered by the Affordable Care Act.

When open enrollment happens at your workplace, take the time to read all of the pamphlets and brochures that your employer provides to you.  Attend informational sessions and learn as much information about your options as you can prior to the deadline.  Ask questions and make sure that you thoroughly understand all of your options.  If you or any of your family members have special needs or chronic conditions. make sure that the plans you are considering cover the services that might be used during the year.

If you haven't yet read the section titled "What are my out of pocket costs?" in the Topics section, now would be a great time to read it and become familiar with the different out of pocket expenses.  Knowledge of these key expenses will help you ask the right questions during enrollment time and lead you to choose the best plan for your individual needs.  All of these items should be clearly discussed in the summary of benefits and coverage.  The summary of benefits and coverage should be in the information provided to you by your employer during the open enrollment period.  If you haven't received such information, please do not hesitate to ask for it.

Please see below for a sample process to follow when choosing a policy for you and your family:

1.  Review all of your plan options and look at the monthly premium for each.  Choose the plans that have a premium that could possibly work in your monthly budget.

2.  From the plans that you have just chosen, review each plan to see if it would cover items that you might anticipate using.  Do you have children?  Make sure that the plan covers well child care and immunizations.  Most plans are now required to cover these expenses through the passing of the Affordable Care Act.  What about emergency room visits and x-rays?  (you never know what kids are going to do!)  Are you a woman of child-bearing age?  Look at the prenatal benefits (just in case!).  If you or any member of your family takes any medications on an on-going basis, check to see if that medication is covered.  See the section on "How do I lower my prescription costs?" in Topics to learn more about formularies.  Think about any other services that you could possibly imagine yourself using during the year and check to make sure they are covered.

3.  Next you can begin to focus in on the out of pocket costs you will incur with each of the plans that you have identified as possibilities.  Look at the deductible amount for each plan and notice that the higher the deductible, the lower the monthly premium.  A lower monthly premium is fine as long as you can afford the deductible.  Now is a great time to start an emergency fund or a nest egg to be able to cover this out of pocket cost.  What is the co-pay associated with the plans you are considering?  This is another out of pocket cost that you will have to pay.  Co-insurance is another source of out of pocket costs.  Look for services that are subject to co-insurance and weigh the possibility of you using these services.  A final number to look at for each plan is the annual out of pocket maximum.  This is the maximum amount that you will have to pay out of pocket per plan year.  Study this number and think of it as your worst case scenario.  Plan for this by putting money away in an emergency fund to cover this cost.

4.  After reviewing all of your plans and becoming familiar with what each plan can offer you, the costs involved with each plan and the monthly premium,  you are now ready to choose the best plan for you and your family!