Since the Affordable Care Act went into effect in 2014, you're less likely than before to make a disastrous mistake -- one that will put you deep in debt -- as long as you enroll in a health plan. Here's why: All health insurance policies now cover a minimum list of benefits, called essential benefits, and all specify a concrete maximum for out-of-pocket costs. There's no annual or lifetime cap on benefits unless your policy predates 2014. Healthcare.gov is the central federal site for finding a health plan.
Newbies to choosing insurance can check out From Coverage to Care, a brief guide to the basics and buzzwords of the Health Insurance Marketplace and insurance in general.
The most cost-effective policy is not always the cheapest. You need to weigh several elements when shopping for coverage, whether you want minimal, modest or premium benefits.
If you see your doctor once a year -- or less -- because you're never sick, look for high-deductible policies to limit your premium costs.
If you clock a lot of time on the road, indulge in high-risk sports or drive after having a drink with friends, look for a plan that covers most of the costs of emergency transportation and rehabilitative care. Whatever accident you sustain could occur far from home, and it could hit you hard.
High deductible policies are particularly cost-effective for young, healthy people. Indeed, the Health Insurance Marketplace makes catastrophic care an option for adults under age 30, as well as for those who are too poor for more generous coverage.
All health insurance policies now cover certain preventive care at no cost to you.
If your policy covers children age 18 or older, and you and your spouse rarely need medical care, consider a bare-bones, high-deductible plan. Most families need more coverage. If your children are young, look for plans that cover walk-in or urgent clinic care for young children and coverage for emergency care and behavioral health for adolescents.
Premiums rise as deductibles fall, sometimes dollar for dollar. If you're likely to need medical services, however, a low deductible plan with higher premiums makes your health expenses much more predictable. If you smoke, are obese, drink heavily, use illegal drugs or otherwise indulge in habits that put your health at risk, don't cut corners on your coverage. Consider comprehensive coverage, too, if you are middle-age or older or if you have:
- A chronic disease such as diabetes
- A body mass index above 25
- An inactive lifestyle
- Family history of early disease
- A stressful job or home life
You may be fine without prescription drug coverage up until middle age, but as your risk increases for serious illness, your risk of needing prescription drugs increases too. If you like a plan that doesn't offer drug coverage, considering getting a separate prescription drug plan, or PDP.
Confidence in Providers
If you've ever disliked a doctor, hospital or clinic enough to switch to a different one, consider preferred-provider organizations, or PPOs. These offer a broader choice of providers than most health maintenance organizations, or HMOs.
Alternatively, look for strong out-of-network benefits so that if you become seriously ill, you can choose providers you trust whether they're in the network or not. Out-of-network benefits are usually covered up to a certain percentage of costs, often 40 to 60 percent. The higher the percentage, the higher the premiums.