How to understand and choose the right health insurance?

iVillage Member
Registered: 10-06-2013
How to understand and choose the right health insurance?
Sun, 10-06-2013 - 11:30am

I am a healthy 35 year old female and need to get health insurance.  It's all very confusing to me and I want to choose an affordable option that's right for me.  I rarely go to the doctor.  The way I understand it, if I choose an option that's $100 a month and has a $10,000 deductible, am I correct in thinking that I have to pay all costs in full icluding visits and prescriptions, until I meet $10,000 per year?  Even if I were to choose a higher monthly option with a $3500 deductible, I still wouldn't meet that $3500 deductible.  It seems that the only way I would actually benefit is if an emergency situation came up, like a hospital visit.  I'm really confused and don't understand the benefit if I pay everything out of pocket until I reach that yearly deductible amount.  Can someone please help me understand?  

Avatar for elc11
Community Leader
Registered: 06-16-1998

"am I correct in thinking that I have to pay all costs in full icluding visits and prescriptions, until I meet $10,000 per year?"

Sort of. If you choose a plan that does not have a set copay (such as $40) for a doctor visit, then you would have to pay the full amount of the visit. However, its likely that the cost of the visit will be "discounted" by the insurance company. They often make deals with the "in network" providers that their members (the insured) pay the amount that the ins co deems acceptable for the visit. So even if the doctor charges the ins co $100 for your visit, the ins may tell the doctor that they can only charge you $60. same with Rx's and lab work etc, you pay a negotiated price.

Also, I believe its now the law that the insurance companies cannot charge you for preventative care such as pap smear, mammogram, annual physical, vaccinations, etc. So you would get those services included at no additional charge if you buy insurance. A benefit of using those services is that they help to spot illness before it becomes serious, so you don't show up at the ER really sick because you've had some undiagnosed condition that was worsening.

The biggest benefits in having health insurance are for a "catastrophic incident"....which at the rates charged these days, could be an illness or injury that's not that serious in the big scheme of things. But if you spend a couple of days in the hospital and need some scans and or a surgery you could quickly run up a $10K bill; and for the peace of mind to know that there is a maximum amount that you must pay out of pocket. If you didn't have insurance and developed an illness the bills could run far higher than you could possibly pay.

If you are a healthy person who rarely needs medical care then you are probably fine getting a plan with a  high deductible and lower monthly premium.

Are you looking on your state's insurance exchange? I've just started looking on shows the main features of the plans by each "metal" (bronze, silver, etc) and has a calculator for whether you qualify for any financial assistance, but doesn't have premium quotes. Not sure if the website will have quotes later, or if I have to talk to a human to get that.

Hope this helped you to understand the "why" of health insurance.