What Criteria Should I Use in Choosing Health Insurance? Covered Health Conditions vs. Deductibles?

When you are choosing an insurance plan as an individual or for the family, it becomes critical to understand exactly what kind of costs you are going to be responsible for when visiting the doctor, consulting a specialist, or having a surgical procedure. It will possibly affect your financial future, which makes it important to not just understand but plan for the financial cost as well as any other related costs.

When comparing different health insurance plans, it’s vital to put your medical needs and those of your family under the microscope. Carefully analyze the type and amount of treatment you have been receiving in the past to help you make an informed choice for the days ahead by looking at the trends.

To help you further narrow down on the best options, look at the respective benefits to know which ones cover a broader spectrum of health services. Some plans may offer you better coverage for aspects such as mental or physical health care services while others could be having better emergency coverages.

The Premium

The premium amount for your particular health insurance plan will depend on several factors, such as the policy type, the possibility that you will actually need to submit a claim under that policy, and other factors like where you live and do. You could also have several options in terms of how often you will need to pay your premiums. Some plans will allow for the payment of monthly installments, while others require that you pay semi-annual or annual payments.

High deductible health insurance plans encourage you to shop around.  This is done by making you responsible for meeting medical costs up-front rather than having an insurance provider covering the costs. In exchange, you pay little-to-no insurance premiums during the whole year.

Low deductible health insurance plans, on the other hand, come with higher premiums but lower deductibles. It will not matter whether you used or didn’t use health services; you have to pay the monthly price.  These types of insurance plans also come with more predictable costs as well as more favorable coverage since they also have lower limits for your out-of-pocket costs

Health Provider Networks

If, for example, you are expecting to use lots of health care because of something like a chronic condition, you already probably know which doctors or specialists you want to be visiting or consulting. So, check them up and see which types of health plans cover them. Alternatively, go for a generally broader network. Typically, PPO health plans are more flexible as they have the biggest networks.

You may also want to work with a health insurance broker or agent as they can guide you to the best health plan that not only meets your budget but also gives you the best coverage.

Out-of-Pocket Expenses                                                               

You should carefully analyze how much your total deductible each year will possibly be. This is the amount of money you will have to meet out-of-pocket before the insurer steps in to meet part of the cost. A number of health insurance plans require that you pay the deductible amount before they cover your doctor’s office visits. Other plans need a co-payment for such visits and that amount is not counted towards the deductible.

You also need to consider how much is your co-insurance, the amount you will have to meet on each medical bill after the insurance has paid its part.

Copayment and Co-Insurance

A copayment, in short copay, is a fixed amount of money you pay after paying a deductible. When on a traditional copay health insurance plan, you will have to meet a fixed amount for each service but in a coinsurance model, you will be paying a fixed percentage per service. 

In some cases, you may not have to first pay the deductible, just a copay. The copay amounts can vary for the different kinds of services even within similar plans, especially in regard to services considered routine or essential and those falling under the domain of a medical specialist.

Treatment like seeing a general practitioner for an annual physical and bloodwork is deemed routine in many plans. For women who have reached a certain age, a gynecological exam or mammogram would be considered as routine. 

Health Insurance Deductible

With a health deductible, the insured individual pays the full amount allowed for all the different services provided until they meet the deductible amount. Deductibles are, however, not the same for all the different coverages within your plan. Because every plan is different, understanding the way different types of deductibles work is very helpful. The deductible is basically what the insured agrees to pay before the insurance plan begins to pay. It’s comparable to the amount you agree to self-insure yourself before you can start claiming on the covered medical expenses. 

Most insurers require that the deductible is met before they agree to cover pharmacy or medical services. Several health insurance plans will agree to meet the cost of basic services such as disease management or checkup, even before you have met the deductible. Plans offered under the Affordable Care Act and Patient Protection pay in full for your routine checkups and other preventative screenings like mammograms or colonoscopy for those over a specific age.


When choosing an insurance policy and plan, it’s helpful to think about the likelihood of you actually using the insurance benefits. For example, if you consider it unlikely that you are going to use your insurance cover very often then choose a health plan that has a higher deductible and lower monthly premium.

If, on the other hand, you think you are likely to rely on your insurance often (if, for example, you have a condition that frequently requires medical care), getting a plan with a lower deductible and higher monthly premium might be your best option. It’s helpful when looking at deductibles, to consider the amount you are likely to meet out-of-pocket in case of something like an emergency.

With the above tips and guides on what you should consider, choosing your health insurance need not be too complicated or stressful.