What to Look Out For When Getting Health Insurance

things to look for when buying health insurance

When you are looking for new health insurance, it can be confusing or overwhelming. It is essential that you get coverage for all the areas that are important to you. There may even be some areas that you do not consider. Then, you find out you need some type of coverage after it is too late. Continue reading this article to make sure you know all the things to look for when buying health insurance.

Compare Plans

There are many different types of plans when it comes to health insurance. It can quickly get confusing with so many acronyms. When considering things to look for when buying health insurance, perhaps focusing on the most common health insurance types would be best. These include HMOs, EPOs, PPOs, and POS options. These options determine your deductibles and co-pays. When you are reviewing different plans, you want to read the summary of benefits. It is helpful if you have an idea of what benefits are essential to you. The plan that allows you access to these benefits is most likely the best one for you. There is also a director that includes all the providers. If you have existing doctors that you want to keep, you must make sure they are in the network. One of the best things you can do for yourself is to create a checklist that includes what is more important to you from health insurance. Consider your deductible, premiums, and out of pocket costs. You also want to consider the coverage you receive. Believe it or not, the most expensive plan is not always the best if it does not provide you the coverage you need.


When considering things to look for when buying health insurance, how to get it is one of the top considerations. Many people find their health insurance through their employer, but there are still some decisions to make. If you cannot get health insurance through your employer, you may need to get your insurance from a marketplace or insurance exchange. Even if your employer offers health insurance, it may be a good idea to check out the insurance marketplace to see if you can find a better plan. However, a better plan does not mean it is going to be more cost effective. In many cases, getting insurance through a marketplace is going to be more expensive.

If you need assistance and the marketplace is not helpful to you, there are insurance agents available to answer all of your questions. It is important to remember that you may not be eligible for a tax credit. There is a potential for income based discounts for your monthly premiums that you may miss out on if you go through an insurance agent versus your employer. These are considerations to make when you are determining where to get your health insurance.

Premiums and Deductibles

Premiums, deductibles, and co-pays are things to look for when buying health insurance. These are the costs that are coming directly out of your pocket. You have a vested interest in how much you pay each year. It is helpful if you understand each of these terms, so you know what they will mean for you.

A health insurance premium is the amount of money you pay each month for your health insurance benefits. You can also pay the premium annually if you prefer. If you are getting your insurance through your employer, the premium is deducted directly from your paycheck. If you are paid bi-weekly, the premium is divided into two payments per month. Typically, the higher your deductible is, means the lower your monthly premiums will cost. You can play around with the premium, and deductible amounts to get them both to a place where you are comfortable.

The deductible is a dollar amount that the policyholder, you, must pay before your insurance pays. The deductible is for a set coverage period, which is usually one year. When the year begins, the amount you have paid toward your deductible is $0. Throughout the year, as you pay money for health services, it goes toward your deductible. On the first day of your next coverage period (typically every Jan 1), the amount you have paid toward your deductible goes back to $0. Once you reach the deductible, the services that are covered will be paid by your insurance company. You still have to pay the co-pay. Keep in mind, the higher the deductible means the lower your premium, but the more you have to pay out of pocket for services. If you do not get sick or use services often, a high deductible plan may be ideal for you. On the other hand, if you require a lot of health services throughout the year, you may want a low deductible plan.

Co-pay is what you pay in addition to your premium and deductible. Whenever you visit the doctor, specialist, hospital, emergency, urgent care, or prescription costs, you have to pay a co-pay. The amount you owe in a co-pay is directly related to the health plan you select. It is crucial that you understand that your co-pay does not go toward your deductible. You pay your deductible in addition to your co-pay. When you have a lower monthly premium, it often means that you will pay a higher co-pay.

Dental Coverage

Dental coverage may be necessary to you. When considering things to look for when buying health insurance, you want to consider dental coverage. There are many health insurance plans that do not cover dental costs. Many health insurance providers offer dental costs in addition to their health insurance package for additional fees. The good news is the premiums are relatively low. On the other hand, dental procedures tend to be expensive when paying for them out of pocket. If dental coverage is important to you, you want to make sure you get a quote for it while looking for health insurance.

Prescription Drug Coverage

When considering all the things to look for when buying health insurance, prescriptions should be one of them. If you are young and healthy, you may not have any medications you take regularly. As you get older, you may have more prescriptions you take. This is when a prescription plan is essential. Medications can be incredibly expensive. When looking for a new prescription drug plan, there are some key items to make sure you capture. First, you want to determine if you will be required to purchase generic medication. Second, you want to know what your co-pay will be for the medicine. Some plans have tiers when it comes to co-pays. You want to understand those tiers if that is the case. If you are switching from one plan to another, do not assume that a medication covered by your old plan is covered on your new one. It is best to verify. If you take medication currently, make sure they are covered. You also want to know if you will have to try a lower tier medication first. Some insurance companies want you to try less expensive medications first to determine if they can address your situation. Finally, some medications require prior approval from the insurance company before you can try them. You want to make sure you are aware of all of these items. Even if you do not think they matter right now, you never know how quickly things can change.

Vision Plan

Just like dental coverage may be necessary to you, a vision plan may be vital to you. If you, when considering things to look for when buying health insurance, you want to think about vision coverage. Many insurances plans do not offer a vision plan as part of their package. Or, if they cover any type of vision problem, it is related to some other condition. For example, if you have an infection in your body and it impacts your eyes, that is covered under your medical insurance. However, glasses and contacts may not be covered. There are separate vision plans available, and similar to dental plans; they tend to have low premiums. In addition, they tend to cover a good amount of vision concerns, including annual eye exams. This is something you want to consider looking deeper into when making decisions about health insurance benefits.

Extra Perks

Every health insurance package comes with its own set of perks. Even the most basic plan may have something in it that no other plan has. All of these things to look for when buying health insurance are essential considerations. When you compile your list of must-haves before you even begin to look for an insurance plan, you could create a secondary list of nice to have. These could be items that would be an extra perk or bonus if covered by your insurance plan. For example, many insurance plans do not consider cosmetic surgery a necessity and do not cover it. There are some more progressive insurance plans that see value in it and may cover a cosmetic surgeon, depending on the exact service and reason. Other insurance companies understand that rehab is an integral part of recovery from addiction and may cover opioid treatment services or other rehab services. If recovery is an area of concern for you, you may want to make sure it is covered. Another interesting service that may be covered by some insurance companies is cremation. If you feel like this is essential to you, you should make sure there is some coverage for it.

Your Own Medical History

When you are considering the things to look for when buying health insurance, you want to look at your own medical history, as well as your family history. This can give you a good indication of what you may have coming your way from a health and wellness perspective. For example, if you have had foot problems in the past, you may need to see a podiatrist. This is coverage you want to make sure you have. If you are an athlete, you may be more concerned with sports medicine. Even if you do not consider yourself an athlete per se, but being athletic and sports are an essential part of your lifestyle, you may need to see a sports medicine doctor. It is critical to understand what coverage you can have. This also includes physical therapy, chiropractic care, an orthopedic surgeon, massage, and acupuncture. Services that have been considered non-traditional forms of health care are now more often being covered, or at least partially covered, by health insurance.

Other Options

When you are considering things to look for when buying health insurance, you may want to understand if your insurance covers short-term or long-term disability. Most often, they do not. However, it is essential to know what your insurance company expects from you. Suppose you have been injured or gotten sick and you are no longer able to work. In that case, your insurance company may require you to research other avenues for income, such as social security disability insurance or workman’s compensation. This could be dependent upon your particular situation. You do not want surprises when you are facing a disability or other difficult situation. It is important to know now if there is some expectation from the insurance company. If you are going to need a workers comp attorney in the event you have been injured on the job; you want to be prepared for that. If you are religious, you may be able to join a non-profit healthcare ministry, such as Jericho Share Health Insurance, in order to receive help in covering the costs of a medical procedure.

These are some essential things to look for when buying health insurance. Of course, you want to make sure you have all of your current needs taken care of, but also look ahead to what care you may need in the future. This can be challenging when you are young and healthy, but you will be glad you did when you have extra health care needs.

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