Phone: 214-691-3535  •  After Hours Nurse: 855-456-6976  •  8325 Walnut Hill Lane, Suite #225, Dallas,TX 75231

health-insurance-questionsOur staff gets asked this question a lot. There is no right answer. So, how do you choose a plan? You may be able to make a more informed decision, by answering the following questions.

How much will the premium cost you? The premium is the monthly fee for the cost of the insurance. Usually, if the premium is high, your out of pocket expense should be lower, i.e. lower deductible or a copay plan instead of a deductible.

If you are looking to cut down on the cost of your monthly premium, a high deductible health plan (HDHP) may be the right option. Many HDHP have lower monthly premiums and some have a health savings account (HSA) attached to them. A HSA allows you to set aside pre-tax dollars to pay for any out of pocket expense. Additionally, many employers will also contribute to your HSA account.

What is an out of pocket expense? Out of pocket expense refers to any expense your insurance company does not pay; this includes copays, deductibles, co-insurance, prescriptions, and non-covered services.

How often did you visit the doctor and what were you seen for? If you were seen for a physical exam, your insurance plan should pay 100% of these visits. Under the Affordable Care Act, preventative services, such as immunizations, physicals, mammograms, and age specific test are covered at 100%. Sick visits and prescriptions, are generally subject to a copay or deductible. If you choose a HDHP, you are responsible for any medical expense, including prescriptions until the deductible is met.

Do you have any medical needs coming up in the next year, i.e. surgery, pregnancy, medication? Some medical expenses can be anticipated. If you are expecting a hospital stay, most plans including PPOs, apply this to your deductible. What does the insurance plan pay once the deductible is met? We've seen anywhere from 65% to 100%. Generally the higher the premium the more the insurance company will pay.

Is there an out of pocket max? This refers to the maximum you will pay out of pocket. After your deductible, you will pay co-insurance. Some insurance plans will have a max amount that you will pay. If you're covered at 100% after the deductible, then there is no other expense if you see an in-network provider.

Is your doctor an "in-network provider?" An in-network provider is a provider that has agreed to take a discounted ratvisite for the services provided. If the provider is out of network, your benefits will be different, usually a higher copay or deductible. For a list of plans we participate in, visit our insurance page. It is also a good idea to check with your insurance company customer service department to verify coverage.

The best question may be, if you are able to save money on your premium, would you put that aside in either a HSA account or another savings type account to be used for medical expenses? If so you could choose a plan where you are responsible for more out of pocket at each visit; but if you are a spender, you are probably better off paying the higher premium and having a lower cost at each doctor's visit.

So which health plan is right for you? The phrase "pay me now or pay me later" comes to mind. Hopefully, this information has helped with the decision making process and we didn't just muddy the waters.