Important Factors to Know when Buying Health Insurance

When it comes to health insurance, buying the right plan can seem a daunting task. With just one or two missed payments or being enrolled in the wrong plan, one could easily find themselves facing expensive medical bills. But the process does not need to be as complicated as it seems. We’ve broken down the key factors to consider when purchasing health insurance.


People tend to focus on the premium when choosing a health insurance plan. The monthly amount one pays for coverage and premiums are obvious expenses associated with health care. But a lower premium is not necessarily the best choice. Lower premiums may come with higher deductibles or narrow networks of doctors or hospitals that participate in the plan—or both.

Out-Of-Pocket Expenses

A health insurance plan typically has several co-payments or out-of-pocket costs. An annual deductible is an amount a person must pay for healthcare services, or for certain preventive services such as immunizations and cancer screenings, before insurance kicks in. The Affordable Care Act exempts some preventive care from the deductible.

Prescription Drug Coverage

Many health insurance plans use formularies or lists of covered drugs that categorize prescriptions into tiers. Some plans may require patients to try lower-tier drugs first or get prior authorization before they pay for expensive medications.


Health insurance plans increasingly offer the convenience of a network of participating providers. Nowadays, most health plans have a network. If one uses a physician or facility outside the network, they could face higher co-payments or even be denied payment. Before switching health plans, make sure preferred doctors are covered in the new plan. Since networks vary from plan to plan, it’s a good idea to double-check the physician list each year before reenrolling in one’s current health plan.

Perks and Benefits

Health insurance providers may offer complimentary wellness programs to their members, such as those designed to promote good health. Many insurers also provide tools for members to make it easy to manage health care benefits, such as online portals, which allow members to reserve appointments and chat with health care professionals via video at any time during the day or night.

Claims History

Reviewing the details of a plan’s deductibles, formulary, and network is more meaningful when one has a grasp of their family’s overall health history. Consider events you would expect coverage for in the coming year—for example, the birth of a baby or a major surgery. These life events may affect which health providers will be available through one’s plan.