How to Shop for the Health Insurance Plan that’s Right for You and Your Family

Stethoscope on Indian banknotes of different denominations HorizontalThere are any number of reasons you might be shopping for a new individual or family health insurance plan: Your current individual plan is too expensive; you had group coverage but due to job loss and the high cost of COBRA coverage, you need a less expensive option; you and your spouse or partner are considering adding to your family and your current individual or family health plan doesn’t offer maternity coverage.

Whatever your reason for shopping for a new health plan, you’re going shopping for a product that can be complicated to understand for the layperson and rightly so: Many consumers go years in between the purchase of a health insurance plan and some consumers – thanks to a lifetime in the work force and group health coverage through their employer(s) – may have never researched or purchased a health insurance plan in their life.

What makes a good health insurance plan? Well this might seem obvious, but the best insurance plan is the one that is uniquely right for you. What do we mean by that? Well you’re going to be shopping for a health plan that is best suited to your current or imminent situation: Let’s say you are the mother of one and you are thinking of adding to your family. You need a health plan that features maternity coverage. You must be medically eligible to get a health plan with maternity coverage. In other words: You cannot already be pregnant when you go shopping for that health plan with maternity. So: Thinking of becoming pregnant or actively trying to become pregnant? Make certain your maternity coverage is in place before becoming pregnant. If you’ve already gone through one pregnancy, you may already know that even a slight complication during pregnancy or the birth of your child can cost a lot of money. Maternity coverage is not something you want to risk going without.

Perhaps you’ve heard of HSA-compatible high deductible health plans. These plans offer the consumer an opportunity to save money on monthly premiums and funding a HSA (Health Savings Account) to pay for qualified medical expenses that come in below your annual deductible is a savvy way to save money and save on taxes. But here again: It’s all about choosing the health plan that is right for you and your family. Choose a high deductible health plan (HDHP) with a family annual deductible of $7000, $8000, or more; don’t have a viable way to fund the HSA; or you and the kids historically go to the doctor several times a year? That HSA-compatible health plan might not be the right health plan strategy for you.

We just used the word ‘strategy’ and that is an important concept during the health plan shopping process: All strategies have different components and learning how the components of a health plan work – either to your advantage or disadvantage – is an important exercise. You will want to learn the basics of how a health plan works. You will want to learn the popular terminology associated with a health plan: What does an annual deductible mean? Insurance companies offer different plans that reach an annual family deductible in different ways. What do terms like co-insurance and co-payments mean and how are they different? What is an annual out-of-pocket maximum? Does the health plan you are looking at feature prescription drug coverage for generic prescription drugs only or for both brand name and generic?

As you can see: Lots of questions you’ll want to know the answers to in order to make the best buying decision and select the plan that is best for you and your family. While I alluded to the fact that this can be complicated and frustrating, there is help readily available. If you’re reading this article on the Mommies Magazine website, you’re likely already a Web savvy consumer. And the Web is where you’ll find an amazing amount of help: Thousands of health insurance agents including many in your own community maintain health insurance websites to serve both prospective and existing clients. These websites may feature a health insurance buying guide and glossary of important health insurance terms, and you can also get information from the insurance companies themselves, who will offer tips on choosing a health plan. It is also important to note that your state government is there with important consumer protection and information on health plans available in your state.

If you find the health insurance website of an agent and feel that the information you’re reading is being presented in a fair and honest way, call that agent. While we all know that health insurance and health care costs in this country are high and getting higher still (Hello Health Reform!), your health insurance agent represents a great bargain: You don’t pay for the expertise of the agent you’ll be working with. That agent’s fees are always paid for by the health insurance companies whose products that agent represents.

I’d like to close this article with an important reminder to perhaps some of this Website’s readers: If you are pregnant and uninsured or underinsured, it is vitally important to your health and that of your child that you receive prenatal care. Please check with your state government to find out about important health care services available in your state.

Ray Carlson is a California health insurance agent who owns an agency and also writes the Vitality California Health Insurance Blog.

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