Buying Health Insurance: What You Need to Know Right Now

The Affordable Care Act 3.0 has kicked off quietly, now that websites are working with far fewer glitches than the first years of open enrollment. What remains to be determined is if people will negatively react to large premium increases that took effect this year. While the uninsured rate has gone down in the U.S. overall, 11 states had increases of uninsured between 2014 and 2015. In another study, eight out of 10 uninsured individuals who looked at a health insurance plan in the past determined they could not afford healthcare, even with cost assistance in the form of a tax subsidy. The reality of rising costs is hitting many Americans in the wallet.

Every dollar is important when you are living on a budget, and there are several factors that can help curb expenses when deciding on healthcare coverage, especially when faced with an increase in costs. When making a decision on which health insurance plan to buy, here are the top things to keep in mind:

Decide which health insurance company you want to work with

When faced with a cost increase to premiums, you want to make sure your insurance company is working for you. Do they have a great website where you can easily access your claims information? Do they offer extras like free telemedicine or gym discounts? Is customer service helpful? If you have the option to purchase a similar plan for far less from another insurance carrier, look into its reputation for customer service and claims processing. Sometimes switching to a different health insurance company can save big coin and provide an equal level of service you are receiving from your current carrier.

Determine which deductible is right for you

While it’s tempting to focus solely on the monthly cost of health insurance, understanding your deductible responsibility needs to remain a focus of your health insurance shopping search. Deductibles are also going up, in addition to premiums, and that number is the total amount you have to pay out of your own pocket before your health insurance company begins picking up most of the bill. If you are injured in an accident or suddenly have a health conditions arise, can you afford the out-of-pocket expense? For many, it would deplete a savings account. Consider your healthcare history over the last few years. If you use medical care outside of preventive care, a Silver or Gold plan could cost less for you overall compared to an economy Bronze plan because it will pay for more of your healthcare claims.

Compare plans both on the federal exchange and in the off-exchange marketplace

At first glance, on-exchange plans offered by the state exchange or federal government can look very attractive. Pricing may seem cheaper, especially on Bronze or Silver plans. But there’s no such thing as a free lunch. Even though plans on a government website look identical to a healthcare plan on another off-exchange website, look at the provider network. Many times on-exchange government plans have a narrow network, only allowing you to see doctors in a specific area in your local community. If you need to see a specialist or travel frequently, you could get stuck with out-of-network bills.

Look at plan details if a lower deductible plan costs less than a higher deductible plan in the same metal level

Frequently your research will result in comparing a $6,000 deductible plan for $257 a month against a $5,050 deductible plan for $241 a month. The formula of high deductible plans being the lowest cost doesn’t apply. Why? Look at the benefits in the $6,000 deductible plan. You should notice additional benefits like a low prescription drug deductible and drug copays, or doctor office visit copays. If doctor office visits and prescription drugs are part of your medical lifestyle each year, paying a little extra each month for copays might be well worth the expense versus paying drugs and doctor visits out-of-pocket.

Health insurance cost increases are a pain in the pocketbook for everyone. The key is to shop for a new health insurance plan and not let your coverage automatically rollover for the next year without looking to see what other options are available for you or your family. It’s also important to remember that if you decide to not enroll in a healthcare plan for 2016, you are subject to a $695 fine per person and $347.50 per child in your household, or a fine of 2.5% of your income.

Open enrollment runs November 1, 2015-January 31, 2016. In order to have coverage January 1, you must enroll in a healthcare plan by December 15.

Shop around like your health depended on it.

The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and

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Colleen McGuire

About Colleen McGuire

Colleen McGuire is an independent consultant who has spent most of her career writing about healthcare and the health insurance industry. For fun she blogs, travels and takes a lot of pictures along the way.