This content was written by LessAccounting.com for small businesses and individuals in the hope of sharing information to help others make informed decisions about health insurance.

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How to Choose a Health Insurance Plan

Personally, we're working with Tim and Wendy of Owens & Associates. I have 52 plans available to me just through Blue Cross Blue Shield of Florida on the Exchange. Not to mention the other 3 insurance carriers in my area that aren't shown on HealthCare.gov/TheExchange.

Having so many options, many with vague plan names like "BlueSelect Everyday 1414OV," makes me feel like I'm beating my head against the wall. I just don't know where to start, so Tim wrote this to help me simplify the logic. (Keep in mind, this advice is catered to me and Blue Cross Blue Shield of Florida Plans. I'm sharing it as an example.)

I asked...

How do I choose a health insurance plan?

Tim Owens answered...

All insurance plans are basically the same and only the network changes the cost.

  1. Blue Option (PPO): These are the most expensive plans with Mayo Clinic network and offers out-of-network benefits. They have the largest list of providers network
  2. Blue Care (HMO): About 5-10% less in cost than a PPO. They only cover in-network benefits. Emergencies are covered in network (in case of life or limb threatening situations). They have a great list of providers, but it is smaller than a PPO.
  3. Blue Select (EPO): This is a smaller network, but still not a bad choice. Costs about 15-20% less than a PPO.
  4. Your decision should be based upon the importance of the maximum out-of-pocket cost, which is normally based upon the need of a surgery or hospital stay. If you are only going to use doctor visits and prescription drugs, then the maximum out-of-pocket is not that big of a risk or concern.
  5. Obviously, the monthly premium dictates your decision, too.

Choosing Plans

A good agent should be able to present you with sensible choices that take into account the coverage you need, as well as your budget. They should guide you to a good policy without pressuring you to buy extras you don't need.

When choosing plans with an agent, here are some points to keep in mind:

  • First, look at the monthly premium, the deductible, and the out-of-pocket maximum for a year.
  • Are there co-pays or coinsurance? Make sure the agent explains these.
  • Depending on your age and health, prescription coverage may be particularly important, so pay extra attention to that part of the plan.
  • If you have children under age 18, does the agent suggest having pediatric dental included in your plan or as a supplementary plan?
  • Does this plan’s out-of-pocket max include the deductible?

Conclusion: Check to make sure your doctor is in the network and that the premium is affordable. If you are the type of patient who only needs a doc and drug occasionally, any plan is almost a good choice for this scenario. If you are going to have a surgery or hospitalization, then out-of-pocket max and the list of providers are important.