What to consider when choosing a health plan

November 2016

What to consider when choosing a health plan

Contact: Jeni Appleby, 414-270-4685, jappleby@wisc.edu; Stephanie Severs, 608-261-1455, ssevers@wisc.edu; Nancy Crevier, 715-732-7510, ncrevier@marinettecounty.com.

Ashland, Wis. — Would you like to explore your health insurance options? Do you get confused when you read health plan information? Are you not sure where to begin? Don’t worry, you’re not alone. The world of health insurance can be complex with a lot of information and unfamiliar words.

One of the first things people think about in regards to their health plan is the cost. There are two categories of costs to know about.

  1. Premium: The monthly payment you make to the insurance company for your health care policy.
  2. Out-of-pockets costs: These are NOT included in your monthly premium. This is the amount you must pay during a year for your health care in addition to your premium. This may include:
    • Deductible: The amount you need to pay before the insurance company will start to pay its part.
    • Co-pay: The fixed amount you pay for a service.
    • Co-insurance: The percentage you pay for a service.

“It is important to choose a plan that meets the household budget, but be sure to also consider your family’s health needs.” says Kathy Beeksma from Ashland UW-Extension office. For someone who anticipates needing to use health insurance frequently during the year, a plan with a lower monthly premium may mean paying more each time health care services are used.

Before you buy a plan, ask:

  1. What hospitals / clinics are in-network? Is my doctor or specialist covered?
  2. How much will I pay to see my doctor or a specialist? What is the co-pay?
  3. How much will prescriptions cost with this plan?
  4. How much will I pay to use the ER? If I get an ER bill for $1,000 or $10,000, what will be my cost?
  5. How much will I pay before the insurance company pays a share? What’s my deductible?
  6. What is the maximum amount I pay for health care in a year? What is the out-of-pocket max?

By asking the right questions, Wisconsinites can find the best plan for their health needs and their budget. To find free, local help signing up for insurance use Covering Wisconsin’s Get Covered Connector online tool at coveringwi.org.

Covering Wisconsin has created a how-to sheet titled Getting Started available online at www.coveringwi.org/learn that summarizes key health insurance words.