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Things to Consider When Choosing a Healthcare Plan

by Maria Palafox, MD

With so many changes in the healthcare system, there are several things to consider when choosing a plan. Being prepared with the right information will go a long way towards making the process easier.

Start by asking yourself a few questions and having the right personal information on hand. When you begin shopping for health insurance, you will need some basic household information. The following is a simple checklist:
Social security number or other ID number.  Be sure to have this for every member of your household applying for health insurance.
Income information.  In order to evaluate the most affordable plans for you and your family, you will need some supporting documents. You may need a copy of your previous year’s tax return, pay stubs or W-2s. Again, you may need this for each person in your household.

Current health insurance policy numbers.  If anyone in your family already has health insurance, you will need to provide those current policy numbers.

Employee coverage form.  This is a government form that you will need to fill out if you currently have the option to get coverage through your employer or your spouse’s employer. You can find this online or at your employer’s Human Resources department.

Things to consider when buying a health insurance plan:

Do you have a doctor you want to keep? Is this doctor in the plan’s network? How does the plan fit within your budget?

There are premiums to be paid monthly or quarterly that you pay just to have health insurance. The deductible is the amount you are responsible for up front whenever you use your insurance.

For example, if you have a $5,000 deductible, you pay this yourself. Once you have met the deductible, meaning you have paid $5,000 of your own money (in addition to the premium), then the insurance will pay the rest according to your plan.

Most plans cover 80 percent of most healthcare costs, but you are still responsible for the remaining 20 percent. Again, this is after you pay monthly premiums and meet your deductible.

Are you on any prescribed medications? Are these medications on the insurance plan’s Preferred Drug List?

Do you quality for a Health Insurance Premium Tax Credit? Do you qualify for Cost Sharing Reductions? Information on this can be found at

What benefits are most important to you? Is it most important to you to keep your current doctor, or is it most important to make sure your medications are covered?

Health insurance is complicated; it can be difficult to read through different insurance plans and figure out what each one covers, however, if you start off by knowing what you need, you can immediately cross out the ones that do not work for your needs.

Good luck!

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