Considerations When Purchasing Health Insurance (2024)

Fortunately, the Affordable Care Act (ACA) makes it easier to get the right health coverage. All health insurance companies in California sell policies with a standard set of benefits (Essential Health Benefits) and fixed cost sharing (except for grand-fathered plans). This makes it easier for consumers to shop for health coverage. It's like comparing apples-to-apples.

Some insurers also offer an alternate plan design. These may have more benefits and the cost sharing may vary.

Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.

Costs

When you buy individual/family coverage, your monthly premiums vary based on a few factors including your age, where you live, the number of persons covered, and how much of your coverage you will pay for out-of-pocket. It can be hard for consumers to pick which cost sharing is best for them. Visit our Health Insurance Costs page for more information that may help you with your choice.

Premiums are calculated differently if you are getting your coverage from your employer (group coverage). Sometimes employers will provide many plans for you to choose from with different levels of cost-sharing. Visit our Health Insurance Costs page for more information about premiums, cost sharing, and out-of-pocket expenses.

You also may have a choice between an PPO, EPO and HMO. Visit our health coverage comparison page for more information about the difference between the three.

Which doctors and other providers can I go to?

  • How large is my provider network?
  • Can I see any provider in the network?
  • Is my current doctor in the network?
  • If I need to choose a new doctor, are there doctors in my area accepting new patients?
  • Will I need a referral from my doctor to see a specialist?
  • Does the plan have hospitals and pharmacies near me?
  • Do I need pre-approval (pre-authorization) from the plan for certain services?
  • If I travel often, what care can I get away from home?

NOTE: If you want to keep or go to a specific provider and/or hospital, check with the insurer. You will need to find if they are a part of the network for the specific product you are buying. Just because a provider is a part of that insurer's network for another plan, it does not mean that he or she will be a part of the plan that you are buying. Visit our Provider Network Adequacy page for more information.

What benefits does the plan offer?

Most insurance policies now offer a standard benefits, making it easier to compare of your choices.Visitour Health Insurance Benefits page for more details.

What quality of care will I get with this coverage? How does it compare to others?

  • The California Department of Insurance can tell you how a company ranks in complaints. You can find out how long it takes to reach a live person when call your insurer and and how many complaints the company gets.
  • Every year, CDI shares a report card with quality information about PPOs. Visit the Health Insurance Report Card for more information.
  • The California Office of the Patient Advocate (OPA) also has information on health coverage and provider quality.
Considerations When Purchasing Health Insurance (2024)

FAQs

Considerations When Purchasing Health Insurance? ›

Patients who select a plan with a high deductibles will most likely have a lower monthly premium, while lower deductibles often have higher monthly premiums. Insurers increasingly require a deductible to be met before covering most medical or pharmacy services.

Which factors do you take into consideration while purchasing health insurance? ›

Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.

Which should be considered when selecting a health insurance plan? ›

Choose the Right Plan
  • Individual Mandate. Most people in California are required to have health coverage. ...
  • Benefits. Your benefit package includes all the benefits, or services, your health plan covers.
  • Costs. Premium costs and out of pocket costs differ from plan-to-plan. ...
  • Quality.

What should a consumer consider when deciding whether to purchase health insurance? ›

Plans with lower premiums often have more limited benefits. You should consider not only the cost of premiums, but also how much you'll pay out-of- pocket when you need health care. Who are you buying health insurance for? You might need coverage just for yourself, just for a family member, or for the whole family.

What to consider when buying insurance? ›

Figure out how much you can afford

Look carefully at policies with bargain-priced premiums - they might turn out to be too limited to be useful for you. Understand how the claims process works, how your providers get paid and what portion you have to pay. Ask if your providers are in the insurance company's network.

What are 3 factors that influence your health insurance? ›

Five factors can affect a plan's monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents. Notice: FYI Your health, medical history, or gender can't affect your premium.

What is the most important factor in health insurance? ›

Costs Associated with a Health Insurance Policy. When considering a health insurance policy, one of the most important aspects to consider is the costs associated with it. These costs can include monthly premiums, deductibles, copayments, and coinsurance.

Is HMO or PPO better? ›

PPOs Usually Win on Choice and Flexibility

Additionally, PPOs will generally have some coverage for out-of-network providers, should you want or need to see one. With HMOs, out-of-network coverage will usually be limited to emergencies; non-emergency services are not usually covered at all.

Which health insurance is the best? ›

Best Health Insurance Companies for 2024
  • Best Overall: Blue Cross Blue Shield.
  • Highest Quality Plans: Kaiser Permanente.
  • Most Health Management Programs: Oscar.
  • Best for Same-Day Care: Aetna CVS Health.

What are the 2 most common health insurance plans? ›

Preferred provider organization (PPO) plan. Health maintenance organization (HMO) plan.

What questions to ask when purchasing health insurance? ›

Five questions to ask when choosing your health coverage
  • Who will your health plan cover? ...
  • Are there specific providers you want to see or facilities you want to use? ...
  • Will your plan cover the medical care you need? ...
  • How much can you afford to pay? ...
  • Do you want flexibility in choosing certain specialists or services?

What are 6 criteria to consider when purchasing health products? ›

Factors To Consider While Choosing The Best Health Product
  • Efficiency And Quality. When choosing a health product look at the effectiveness of the product to heal or providing relief to the condition you are suffering from. ...
  • Formulas And Dosages. ...
  • Avoid GMOs. ...
  • Avoid Products With Additives And Colorings. ...
  • Look At The Cost.
Jul 16, 2019

Who are the top 5 health insurance companies? ›

The five largest health insurance companies are UnitedHealth Group, Anthem, Kaiser Permanente, Ambetter and Humana. Currently insured?

What are the 3 most important insurance? ›

As you hit certain life milestones, some policies, including health insurance and auto insurance, are virtually required, while others like life insurance and disability insurance are strongly encouraged.

What are the 3 typical requirements in an insurance policy? ›

The Conditions

Common conditions in a policy include the requirement to file a proof of loss with the company, to protect property after a loss, and to cooperate during the company's investigation or defense of a liability lawsuit.

What is a deductible in health insurance? ›

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a. copayment.

What are 5 factors that are used to determine the cost of insurance premiums? ›

Five factors that affect your auto insurance payment are how often you pay your premium, your vehicle, your driving history, your credit history and your state's coverage requirements. Insurance companies use most of these factors to determine how likely you are to file a claim and thus how risky you are to insure.

What are 5 factors that determine your insurance premium? ›

Common factors include:
  • Driving record. ...
  • Garaging of the vehicle. ...
  • Gender and age of drivers. ...
  • Marital status. ...
  • Prior insurance coverage. ...
  • Miles driven and use of vehicle. ...
  • Make and Model of vehicle. ...
  • Licensed drivers in your household.

Which factors are taken into consideration when an insurance company determines the premium? ›

Insurance premiums are influenced by factors such as the type of coverage, policy limits, deductibles, and the insured's risk profile.

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