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How to Choose Insurance Coverage

Choosing health insurance can be complicated. Before you make a decision, you need to know how to compare health insurance options accurately. A health insurance plan might feature low monthly payments but prove high in other costs. So take time to read your plan, review the costs and compare the benefits carefully - then you’ll know which Pennsylvania health insurance plan adds up to the best value for your needs.

Things to consider when shopping for a health insurance plan

Everyone’s needs are different, and there may be several factors to consider in your choice. Five important questions to ask yourself: 

  • What do I need?
  • What can I afford?
  • What is included in the plan?
  • How does the plan work?
  • Does the network of healthcare providers meet my needs?

To find a licensed health insurance company in your area, contact a licensed insurance agent.

Understanding Fees and Costs

The different fees and costs can get confusing. Here are a few of the most common terms explained in simple language:

  • Annual limit - The maximum amount an insurance company will pay toward your covered expenses for a particular benefit during a calendar year.
  • Benefits limit - A specified limit on the visits or dollars allowed for a covered service.
  • Coinsurance - The percentage of medical care you’re responsible to pay for that the insurance company does not. (For example, your coinsurance for a hospital stay may be 20 percent of the total cost, while the insurance company pays 80 percent.)
  • Copay - The flat fee you pay every time you get medical care, such as a visit to your doctor or the emergency room.  Copays generally are higher to see a specialist.
  • Costs associated with using an “out-of-network” provider - With many health plans, you may have to pay part or all of the costs if you use a provider who is not in the plan’s network.
  • Deductible - The dollar amount you’re responsible to pay to your doctor or  other medical provider before your insurance company covers costs.
  • Lifetime maximums - The maximum out-of-pocket costs you might be responsible to pay in your lifetime.
  • Lifetime limits - The maximum amount an insurance company will pay toward your covered expenses for a particular benefit during your lifetime.
  • Maximum out-of-pocket - The maximum amount you’re responsible for paying in a plan year.
  • Premiums - The fee you pay to the health insurance company for your health insurance coverage. The amount of your premium payment depends on the type and level of your coverage, and on whether part of the premium is paid by your employer.

Open or Special Enrollment

Open enrollment is a specific period of time during the year in which you are allowed to enroll in or switch plans.

  • It is your chance to compare the different health insurance plans offered to you by your employer or on the federally-facilitated marketplace, or to switch plans if you choose.
  • If you miss this period, you may not be able to enroll in your plan until the next year.
  • There are special exceptions, such as when you change jobs or have another life-changing event like a marriage, a new child, divorce or death, which allow you to enroll in or switch plans outside of your open enrollment period. For more information, download our PDF about open enrollment here.

Want to learn more about how to shop for health insurance?

Download our Guide to Health Insurance to help you make the right decision.






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