Tips for comparing health insurance plans

Identifying your healthcare needs

Consider the following NEED categories related to the care you’ve received in the past and your current health situation to help identify the healthcare services you may need in the future:

• N - Names: names of healthcare professionals and facilities you prefer such as a primary care physician
• E - Events: events scheduled in the future like checkups, procedures, surgeries and additions to your family
• E - Emergencies: emergency situations involving an ambulance or an emergency room
• D - Decisions: decisions regarding your health including treatments and medications

Prioritizing your needs

Using the information from the NEED categories above can help you identify the care you may need in the future. Making a list in order of importance can help you decide what to focus on when comparing the details of each plan.

Comparing plan details that align with your needs

Consider comparing the details of each plan using the CARE categories below:

C - Coverages

It may be helpful to start by comparing coverages for the services you currently use and wish to continue.

Here are some common coverages to compare:

• Scheduled services: services for preventive care like routine checkups and health screenings
• Emergency services: emergency room visits and ambulance services
• Rehabilitation services: physical, occupational and speech therapy
• Virtual services: visits online (sometimes called telehealth)
• In-patient services: hospital visits that include overnight care
• Counseling services: mental health and wellness care
• Expectant parent services: prenatal care including ultrasounds and routine checkups

A - Access

If you have a primary care physician you want to keep or a pharmacy you prefer, reviewing each plan’s provider network can help you understand whether you’ll have access to them under each plan.

Common access areas you may want to review:

• In-network providers: medical professionals included in the plan
• Network locations: locations of hospitals, walk-in clinics and pharmacies included in the plan

R - Rules

Some plans have rules you have to follow that can affect the way certain services and medications are covered.

Common rules include:

• Preauthorizations: pre-approvals required for certain services and medications to be covered
• Limitations: limits on the quantity of certain services and medications covered
• Referrals: requirements for meeting with a primary care physician before seeing a specialist

E - Expenses

It’s helpful to not only compare monthly payments but also all the other expenses you may incur.

Common expenses include:

• Premium: the amount you pay monthly for coverage
• Deductible: the amount you pay before insurance starts helping
• Copayment and coinsurance: your share of expenses for office visits and prescriptions
• Out-of-pocket maximum: the most you may pay in a year before insurance covers 100%
• Spousal fee: the fee to add your spouse to your health insurance plan if they have the option of getting it through a different employer

Using the NEED CARE approach can be helpful when comparing plans and looking for one that includes the care you may need from healthcare providers in the future.