Tips for choosing your health insurance plan through work
Are you trying to choose a health insurance plan offered through your employer? Choosing a health plan for the year ahead is an important decision. And if it's open enrollment time at your company, it's your time to explore the available health plan options before you enroll.
Use this checklist and watch our open enrollment video series to help weigh the options and decide which health plan may be best for you. Let's get started.
If mostly for minor care needs:
You may need less coverage if you see the doctor occasionally for preventive care (like your annual checkup and routine screenings), minor illness or injury. To save money, you might choose the less expensive plan where you pay less in premiums in exchange for less coverage.
If mostly for major or frequent care needs:
You may need more coverage if you’re planning for a major procedure, seeing the doctor often or if you take specialty medications. To save money overall, this typically means paying more in premiums in exchange for more coverage from your plan. These plans usually have a lower deductible and out-of-pocket limit so that your plan can help you share costs faster.
Do you have a major surgery planned? Or maybe you’re pregnant or hoping to become pregnant. Big life changes can come with big health care needs — so it’s important to pick a plan with the right level of coverage. Research what your care needs could cost on average, and consider choosing a plan with a lower deductible and out-of-pocket limit so your plan can help you share costs faster.
Whether you’re taking regular prescriptions or specialty medications, what they cost varies based on each plan. Check to see if the plan covers generic and brand name versions of the medication. Also make sure you receive your medications from a pharmacy that’s in network, otherwise they may not be covered or you may pay more.
Generally, the more people you have on your health plan, the more coverage you may want. Consider the needs of all family members covered by your plan.
Lower premium plan
- May be a good fit if you don’t have any major care needs
- Takes less money out of your paychecks each month, but you may pay more when you get care
- Doesn’t include coverage for out-of-network providers
Health maintenance organization (HMO) plans are a common type of health plan that typically offer lower premiums. HMO plans usually require you to choose a network primary care provider (PCP) who coordinates your care. Your PCP also refers you to specialists if needed, helping to keep care and costs in network.
Lower copay plan
- Consider this option if you see the doctor more often and want flexible coverage
- Offers the option to spend less money when you visit a doctor, clinic or urgent care
- Takes more money out of your paychecks each month to have lower copays and coinsurance
Preferred provider organization (PPO) plans may offer lower copays and out-of-pocket costs when you get care. Premiums tend to be higher, but you’ll typically get more flexibility to choose the providers you see. Out-of-network care is usually covered. PPO plans usually have a deductible you’ll need to meet before the plan starts paying for care.
See if an HSA, HRA or FSA is available
Your employer may offer health accounts that can help you pay for eligible expenses like doctor visits, copays and health care-related products and services. These accounts offer tax advantages, which may help you save money and better manage how you pay for care.
Common account types include a health savings account (HSA), health reimbursement account (HRA) and flexible spending account (FSA). They all work a bit differently — for example, you fund an HSA or FSA with payroll contributions (your employer may contribute, too), while an HRA is funded entirely by your employer.
Get more tips for choosing a health plan
Watch this helpful video to dive deeper into how to choose a health insurance plan from your employer.
Tips for choosing a health plan
