Shopping for Health Insurance

If you’re unhappy with the insurance you have and are looking for a change, or if you don’t have health insurance, you have options to consider. If you take some time now to understand and compare these options, it may save you money and improve your access to quality care.

Don’t be surprised if you find this process overwhelming at times. It’s difficult to know where to begin. The steps below are provided to help you gather the information you need to make an informed choice that’s right for you and your family.

Step 1: Evaluate your healthcare needs

• Take a close look at your budget and spending habits, including how much you have spent on healthcare in years past. For example, if you don’t have much savings, it would be difficult to cover an unexpected, big expense, which could happen if you have a high deductible. If you want a lower deductible so you don’t have to pay so much before it’s met, you’ll probably need to budget for a higher monthly premium.
• Consider how often you see your doctor. For example, if you go fairly often in addition to your regular checkup, you may be willing to pay a higher monthly premium so that the insurer will share more of the cost of copayments and other expenses.
• Know your priorities and preferences and try to anticipate your healthcare needs as much as possible for the coming year. For example:
  • You want to keep the primary care physician you have now.
  • You can only afford $600 a month for a premium.
  • You may need surgery but can only afford about $5,000 at most in out-of-pocket expenses, including your deductible and anything else insurance might not cover.

If you already have health insurance, continue to Step 2. If you don’t have coverage, go to Step 3.

Step 2: Evaluate your current plan

Does your current healthcare plan meet your expectations in Step 1? If you aren’t sure, check your plan documentation (which may be online) or call your plan administrator. Your policy information should include contact information, or you may find a phone number or website on your insurance card.

You can also request your plan’s Summary of Benefits and Coverage (SBC) (see an example) and learn the definitions of commonly used health insurance terms.

Keep in mind that if your current insurance complies with the Affordable Care Act’s (ACA’s) requirements and it’s affordable, you may have to wait until open enrollment to buy insurance from the health insurance marketplace or directly from an insurance company.

Step 3: Get health insurance

• Shop for a new health insurance plan. 
• If you or a family member recently lost your health insurance benefits because of a layoff, death, or other qualifying event, consider continuing your coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
• Purchase insurance directly from a private insurer (but only after carefully reviewing the plan to confirm that it meets all of your requirements). You can do this on your own or with the help of an insurance agent or broker.
• Visit www.Healthcare.gov to determine if you’re eligible for benefits from a government program, such as Medicare, Medicaid, or Children’s Health Insurance Program (CHIP), and to access the federal or state (if your state has one) health insurance marketplace to compare plans and apply for any subsidies or tax credits.

For the most current information on deadlines and penalties, it’s important to keep up-to-date on healthcare reform developments at both the federal and state levels.