Getting health insurance can be incredibly confusing for most people. Especially trying to understand rules and regulations in Obamacare, as politicians wrestle for what it will become, changing financing for Medicare and Medicaid, and what seems like hundreds of private insurance options, and the endless plans they have available. And we’re not even getting into the small print.

We wrote this guide for young people who are just coming out from their parents’ insurance plan and need to get something on their own, or for first-time insurance seekers who have either never had insurance or have recently come from a country with a completely different system. For example, the UK’s NHS system works well and while some people opt for private health insurance in Great Britain, going with providers like BMI Healthcare or Axa PPP and life insurance at Anorak, a lot of British people don’t feel the insurance squeeze until they have moved to the US for either work or private reasons.

In fact, some of our British and Canadian friends were so shocked when they were faced with having to pick health insurance that’s best for them in America, that we got inspired to make it as easy as possible:

Recognize Your Choices

The American health system offers some of the best quality care in the world. Having said that, it also offers it at some of the highest prices in the world. That’s like saying that America has some of the most beautiful mansions in the world – is this useful information for an average homebuyer?

The easiest place to go is still usa.gov/finding-health-insurance. The forms are easily downloadable. Your subsidies and marketplace availability will depend on where you live, but it’s easy to fill out all the blanks and quickly see what you qualify for. The prices are better than going out and looking for insurance in the market, where it’s hard to find objective information.

If you want to try it on your own, chances are that your workplace is giving you a leg up. Most people with private health insurance get it through their employer, where their employer will pay for a large chunk of monthly health insurance costs. You can often pick what tier of coverage you’d like to participate in, and if you’d like to include family members for additional costs. This is called group health insurance, and 49% of Americans get insured this way.

Know the Talk

We have put together a glossary of terms – things you need to arm yourself with when picking the best health insurance choice for yourself. A lot of the time, people don’t know what they’re getting because of the complicated vocabulary and all the fine print.

Co-payment – this is what you will pay when you receive a service, for example, after a visit to the doctor’s office. While your insurance covers some of the costs, you will most likely be required to pay somewhere between 15 to 50$, depending on your coverage.

Complications of Pregnancy – pay attention to the fine print with this one, because non-emergency C-section is not considered a “complication” and will not be covered.

Excluded Services – things not covered by your plan, which means you will be stuck with 100% of the bill.

Allowed Amount – this is the absolute maximum that your insurer will pay. If your health services cost more, you will be charged with the remainder of the bill. This may also be called “payment allowance”, “negotiated rate”, or “eligible expense” – depending on your insurance.

Prescription Drug Coverage – another fine point to watch. Some plans don’t do a good job co-paying for prescription medications, which can cost a pretty penny. Definitely one of the most important things to consider when looking at a plan.

Deductible – This is a shocker in some insurance plans. If your deductible is 2,000$, you have to spend 2000$ out of pocket before your insurance kicks in. And be sure to check what deductible services are eligible for this – if the particular medical service you need isn’t covered under this deductible, you might spend thousands of dollars on medical care without coverage, and without it counting towards your deductible. Check what is covered and if it’s beneficial to you! A benefit of these high deductibles might be the fact that after that magical cut-off point, your insurance will cover all of your costs.

These are some of the most important terms when looking at health insurance. You can find more at cms.gov – we recommend it because this website is impartial and not sponsored by private health insurance groups that might want to lure you on board with biased information.

Talk to a Person

Finally, although it might mean some time on hold, we recommend you talk to a representative of a particular insurance group in order to get all of your questions answered. If you’re picking health insurance, and a particular plan looks great to you, don’t hesitate to write down a list of questions and be adamant about getting the right answers. In this business, it’s best to get the whole story straight from the beginning, before getting any expensive surprises.

If you’re like 49% of Americans, you can not only talk to your insurance provider but your HR team as well. They will probably have more time to sit down and explain the fine points to you. Generally, we are all about these three points:

  • Know your needs
  • Do the research
  • Get the answers

Being inquisitive is key – even if you have to invest a lot of your time. We wish you luck in finding the best health insurance on the market – it’s out there!

Cite this article as:
Editorial Staff, "Step by Step Guide to Getting the Best Health Insurance," in Medicalopedia, February 13, 2020, [Permalink: https://www.medicalopedia.org/8357/step-by-step-guide-to-getting-the-best-health-insurance/].