How to Choose a Health Plan in 10 Minutes
A simple method to pick between plans using your expected healthcare use—not guessing.
If you've ever stared at two plans thinking "I have no idea which is better"—you're not alone.
A health plan isn't one price. It's two prices: what you pay monthly (premium) and what you pay when you use care (deductible, copays, coinsurance).
New to health insurance? Start with How to Read Any Health Plan in 5 Minutes first.
Step 1: Pick Your Healthcare Lane
Which sounds most like your expected year?
- 1-2 routine visits, maybe urgent care once
- Few or no prescriptions
- Ongoing prescriptions or specialist visits
- Regular labs, therapy, or physical therapy
- Planned procedure, pregnancy, or chronic condition
- You want protection from surprise costs
Not sure? Compare plans using Lane A and Lane C. That's enough to avoid most bad picks.
Step 2: Compare the 4 Key Numbers
For each plan you're considering, write down:
- Annual premium (monthly × 12)
- Deductible
- Out-of-pocket max
- Your lane (A, B, or C)
Your estimated cost = Annual premium + Expected care costs (capped by OOP max)
You don't need perfect math. You need a good decision.
Step 3: Understand Plan Types
These labels mostly affect networks and flexibility:
- PPO — Most flexibility, higher premiums, some out-of-network coverage
- HMO — Lower cost, must use network, may need referrals
- EPO — No out-of-network except emergencies, usually no referrals
- HDHP — Lower premiums, higher deductible, often HSA-eligible
A "PPO" isn't automatically better than an "HMO." The numbers and your doctors decide.
Step 4: Answer These 5 Questions
- Are your doctors in-network?
- Do you take prescriptions regularly?
- Can you afford the deductible if something happens in January?
- Do you want predictable copays or lower monthly costs?
- Is worst-case protection (lower OOP max) more important than saving on premiums?
If you can't handle a high deductible early in the year, choose a plan with lower deductible and higher premiums.
Common Scenarios
- Look for: Lower premium, HSA-eligible HDHP
- Accept: Higher deductible you probably won't hit
- Watch: Make sure your out-of-pocket max is still reasonable
- Look for: Good copay structure, drugs on formulary
- Accept: Moderate premium for predictable costs
- Watch: Check if your specialists are in-network
- Look for: Lowest out-of-pocket max
- Accept: Higher premium for better protection
- Watch: The OOP max matters more than the deductible here
What's Next
Once you've picked your plan, decide how to pay for care: HSA vs FSA: The One Rule That Decides.
Want personalized guidance for your situation?
This article is for educational purposes only and does not constitute tax, legal, or medical advice.
Frequently Asked Questions
Which plan type is best?
Should I pick the cheapest premium?
What if I'm not sure how much care I'll need?
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