12 Open Enrollment Pro Tips That Can Help You Choose A Health Plan

Health insurance may not be your fave, but it's still a good idea to get covered.

Health insurance can be complicated and confusing, and it's incredibly frustrating that Americans pay more per person for healthcare than the rest of the world. But unless things change dramatically, you'll probably want to have some kind of coverage in case you get sick or injured in 2022.

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If you're planning to get health insurance for 2022 on the Affordable Care Act (ACA) exchange at Healthcare.gov, open enrollment is up and running from November 1, 2021 to January 15, 2022. Or, if you get coverage through an employer, many workplaces are also running their open enrollment periods around this time too.

FYI, open enrollment is the time when you can sign up for coverage or change your existing coverage. Outside of open enrollment, you won't be able to make changes unless you have a qualifying event such as getting married or having a baby, or if you lose your current coverage.

To get some tips for choosing the right health plan for you this open enrollment season, I talked to Lisa Lough, President of Cigna Individual and Family Plans, and she broke it all down in an extremely helpful way. Here's what she had to say:

Note: The advice here is very general and may not fit your specific situation. For personalized advice, we recommend speaking with a finance pro.

Comparing health insurance plans can feel like trying to take a test in a foreign language that you didn't study for. So first, Lough gave us a much-needed refresher on some key health insurance buzzwords.

1. Start comparing plans by checking out the premiums, aka monthly payments, for the plans available to you.

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"The premium is the price you’ll pay for your health insurance plan — typically on a monthly or twice-per-month basis. It’s like a subscription fee you’d pay for Netflix. Premium amounts vary by insurance carrier, the type of plan you choose, and — if you’re buying through the Affordable Care Act (ACA) exchange instead of an employer — by your age and location."

2. If you're getting a plan on the ACA exchange, see if you qualify for subsidies. These are tax credits that can lower your premiums.

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"If you buy insurance through the ACA exchange, you may be able to qualify for subsidies — or tax credits — that can lower your monthly healthcare expenses by ensuring your premium amount is based on your income level. Due to the pandemic, more people than ever qualify for subsidies on the individual marketplace, so be sure to check if you qualify."

3. Next, take a look at the plan's deductible. That's the amount you'll have to pay out of pocket before your coverage kicks in.

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"A deductible is the amount you will be responsible for out of your own pocket for eligible medical services or medications before your plan helps to pay for covered services. Check to see whether a plan you’re considering has a separate deductible for healthcare services and for pharmacy. If so, you’d be responsible for each. Make sure you can afford the deductible on the plan you choose. Keep in mind, though, that some preventive care is low- or no-cost even before your deductible is met."

"In some plans, you pay all your eligible expenses until your deductible is met. Other plans use a co-pay, which is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. If your plan has a co-pay, those costs may count toward meeting your deductible."

4. You'll also want to look at the coinsurance percentage. This represents what portion of your medical bills you'll be responsible for paying after you hit your deductible.

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"Once you meet your deductible, your plan begins to share the costs with you. Coinsurance refers to how you split costs with your insurance carrier. For example, if your coinsurance is 20%, once you’ve paid your deductible for the year, you pay 20% of the cost of your covered medical bills, and your health insurance plan pays the other 80%. The higher your coinsurance percentage, the higher your share of the cost is. You are also responsible for any charges that are not covered by the health plan."

5. Check the out-of-pocket maximum too. This number represents the most you would pay for covered medical care within a year.

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"Plans set a limit on how much you could pay for covered medical expenses in a year, and that is your out-of-pocket maximum. This amount includes money you spend on deductibles, copays, and coinsurance. Once you reach your annual out-of-pocket maximum, your health plan will pay your covered medical and prescription costs for the rest of the year."

6. Finally, take a look at the plan's network. This is the group of doctors and other providers that accept this insurance.

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"The last thing to check while shopping is a plan’s network. A network is a group of medical care providers, such as doctors, pharmacies, and specialists, that are contracted to serve customers of certain insurance plans. You’ll want to make sure you and your family’s preferred doctors and pharmacies belong to the network of the plan you’re choosing or that you choose a doctor who is in-network for that plan if you don’t already have one. Otherwise, you’ll rack up unwanted costs for out-of-network services."

Phew, with the vocab out of the way, Lough filled us in on the different kinds of health plans you might see during open enrollment, and some pointers for more specific situations.

7. Health plans come in a lot of varieties (with so many acronyms), but what it all boils down to is how each plan allows you to access care.

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"The different types of health insurance include health maintenance organizations (HMOs), exclusive provider organizations (EPOs), point-of-service (POS) plans, and preferred provider organizations (PPOs). The main differences between these kinds of plans are whether you are required to have a primary care physician, whether out-of-network coverage is included, and whether you’re required to receive a referral to access various kinds of services. As you choose between plans, always check whether your doctor is in-network and think about the amount of flexibility you need in where you access care."

8. High-deductible health plans can be a low-cost option if you're generally healthy and don't usually see a doctor more than once a year.

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"If you’re in good health and don’t visit a doctor often, health insurance plans with higher deductibles typically have lower insurance premiums and could help save you money. Most health plans, including all plans available through the ACA marketplace, cover basic preventive services, such as an annual physical, recommended screening tests, and vaccines, at no cost."

9. If you have an ongoing or chronic condition, you might be able to save on out-of-pocket costs by going for a plan with a higher premium and a lower deductible.

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"Chronic conditions usually require regular medication and more frequent doctor appointments, even costly hospital stays or surgeries. Consider a health plan that has lower deductibles and coinsurance, so you can better control the costs."

"Better yet, check to see whether there’s a condition-specific plan offered, as these will be more tailored to your healthcare needs and can help keep related healthcare costs down. For example, through the ACA exchange, Cigna offers plans for asthma, COPD, and diabetes — which offer low- and no-cost benefits for select equipment and supplies, preventive care services, common medications, and medical services needed to manage these conditions."

10. If mental health coverage is important to you, check the Summary of Benefits to see what a plan will cover.

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"To figure out if a plan offers mental health coverage, you’ll usually need to look at the Summary of Benefits. This is a document that shows what services the plan covers and what you pay for covered services. Typically, there will be a line describing coverage for mental health, behavioral health, or substance abuse services. Depending on your mental healthcare needs, this may be one of the deciding factors in how you choose your plan."

"You can also look at the plan brochures to see if there are any additional plan features [like telehealth or online therapy] that impact mental healthcare access or affordability."

11. If you and your partner both have access to health insurance plans through work, you'll want to carefully compare them to choose the best plan for both of you.

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"Run the numbers, and run them different ways — planning for lower and higher healthcare needs during the year. Check each employer plan to see which ones provide affordable premiums, low deductibles, and a network with your family’s preferred doctors. Check to see how the premiums and deductibles change for the employee versus the employee plus a spouse or partner."

12. And if you're looking to add your kid to your plan, it might make sense to consider paying a higher premium to cut down on unpredictable out-of-pocket costs.

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"If you have kids, chances are it’s harder to estimate what your healthcare expenses will be. A fall on the playground, a bout of the flu, and other unexpected illnesses or injuries can quickly drive up costs. A plan with a lower deductible and higher premium that pays for a greater percent of your medical costs may be better for your family."

Do you know of any more helpful tips for choosing a health plan? Share your wisdom in the comments.

And for more stories about life and money, check out the rest of our personal finance posts.