Considerations When Purchasing Health Insurance (2024)

Fortunately, the Affordable Care Act (ACA) makes it easier to get the right health coverage. All health insurance companies in California sell policies with a standard set of benefits (Essential Health Benefits) and fixed cost sharing (except for grand-fathered plans). This makes it easier for consumers to shop for health coverage. It's like comparing apples-to-apples.

Some insurers also offer an alternate plan design. These may have more benefits and the cost sharing may vary.

Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.

Costs

When you buy individual/family coverage, your monthly premiums vary based on a few factors including your age, where you live, the number of persons covered, and how much of your coverage you will pay for out-of-pocket. It can be hard for consumers to pick which cost sharing is best for them. Visit our Health Insurance Costs page for more information that may help you with your choice.

Premiums are calculated differently if you are getting your coverage from your employer (group coverage). Sometimes employers will provide many plans for you to choose from with different levels of cost-sharing. Visit our Health Insurance Costs page for more information about premiums, cost sharing, and out-of-pocket expenses.

You also may have a choice between an PPO, EPO and HMO. Visit our health coverage comparison page for more information about the difference between the three.

Which doctors and other providers can I go to?

  • How large is my provider network?
  • Can I see any provider in the network?
  • Is my current doctor in the network?
  • If I need to choose a new doctor, are there doctors in my area accepting new patients?
  • Will I need a referral from my doctor to see a specialist?
  • Does the plan have hospitals and pharmacies near me?
  • Do I need pre-approval (pre-authorization) from the plan for certain services?
  • If I travel often, what care can I get away from home?

NOTE: If you want to keep or go to a specific provider and/or hospital, check with the insurer. You will need to find if they are a part of the network for the specific product you are buying. Just because a provider is a part of that insurer's network for another plan, it does not mean that he or she will be a part of the plan that you are buying. Visit our Provider Network Adequacy page for more information.

What benefits does the plan offer?

Most insurance policies now offer a standard benefits, making it easier to compare of your choices.Visitour Health Insurance Benefits page for more details.

What quality of care will I get with this coverage? How does it compare to others?

  • The California Department of Insurance can tell you how a company ranks in complaints. You can find out how long it takes to reach a live person when call your insurer and and how many complaints the company gets.
  • Every year, CDI shares a report card with quality information about PPOs. Visit the Health Insurance Report Card for more information.
  • The California Office of the Patient Advocate (OPA) also has information on health coverage and provider quality.
Considerations When Purchasing Health Insurance (2024)

FAQs

What should a consumer consider when deciding whether to purchase health insurance? ›

Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.

What are the major considerations in deciding about a health insurance plan? ›

that you use or want to use are in-network and participating with the plan you choose. Second, you should consider the total health care costs (monthly premium, deductible, copays and coinsurance, and out-of-pocket maximum). Generally, plans with higher premiums have better coverage and lower out-of-pocket expenses.

What to consider when buying insurance? ›

Figure out how much you can afford

Look carefully at policies with bargain-priced premiums - they might turn out to be too limited to be useful for you. Understand how the claims process works, how your providers get paid and what portion you have to pay. Ask if your providers are in the insurance company's network.

What should you consider look at when choosing an insurance plan? ›

If you're starting a family, think about the medical needs you and your family may have. When choosing an insurance plan, check to make sure that the care you need is covered. You can find out what services are covered by each health plan in the online Marketplace. Does health insurance cover prescriptions?

What should you always do when purchasing health insurance? ›

Four things you should think about when choosing coverage - costs, provider network, benefits, and quality.

What are 6 criteria to consider when purchasing health products? ›

Factors To Consider While Choosing The Best Health Product
  • Efficiency And Quality. When choosing a health product look at the effectiveness of the product to heal or providing relief to the condition you are suffering from. ...
  • Formulas And Dosages. ...
  • Avoid GMOs. ...
  • Avoid Products With Additives And Colorings. ...
  • Look At The Cost.
Jul 16, 2019

What are the 3 main factors used in determining health insurance premiums? ›

Factors affecting health insurance premiums
  • Age and Gender:
  • Medical History and Current Health Condition:
  • Coverage Type and Level:
  • Location and Local Healthcare Costs:
  • Deductibles, Copayments, and Coinsurance:
Sep 1, 2023

What are considerations in insurance? ›

Consideration. This is the premium or the future premiums that you have to pay to your insurance company. For insurers, consideration also refers to the money paid out to you should you file an insurance claim. This means that each party to the contract must provide some value to the relationship.

What are at least five factors to consider when selecting an insurance company? ›

Here are the main points to keep in mind when selecting an insurance company:
  • Licensing. Not every company is licensed to operate in each state. ...
  • Price. Many companies sell insurance policies and prices vary greatly from one to another, so it really pays to shop around. ...
  • Financial Solidity. ...
  • Service. ...
  • Comfort.

What are the 3 typical requirements in an insurance policy? ›

The Conditions

Common conditions in a policy include the requirement to file a proof of loss with the company, to protect property after a loss, and to cooperate during the company's investigation or defense of a liability lawsuit.

What are 3 factors that insurance companies look at to determine how much your insurance is going to cost? ›

Understanding what determines your auto insurance premiums can uncover new ways to save. Auto insurance rates depend on factors such as your age, gender, location, the kind of car you drive, your driving record and possibly even your credit score. Here are 12 things that can influence the cost of your car insurance.

What are some key considerations when selecting a suitable life insurance policy? ›

5 Factors to Consider Before Choosing Life Insurance
  • Assess your current financial situation. It's critical to have life insurance in place to protect your loved ones should something happen to you. ...
  • The best time to get life insurance. ...
  • The amount of coverage you need. ...
  • Bonus tip: Don't focus too much on premium cost.
Feb 7, 2023

What is the best health insurance in the USA? ›

Best Health Insurance Companies for June 2024
  • Best Overall: Blue Cross Blue Shield.
  • Highest Quality Plans: Kaiser Permanente.
  • Most Health Management Programs: Oscar.
  • Best for Same-Day Care: Aetna CVS Health.

What factors should be considered when evaluating health insurance plans? ›

5 Things to Consider When Choosing Your Health Coverage
  • Type of Plan and Provider Network. Do the health care provider s, hospitals and pharmacies you prefer fall within the plan's network ? ...
  • Premiums. How much will you pay per month for coverage? ...
  • Deductibles. ...
  • Co-pay or Coinsurance. ...
  • Coverage of Medicines.

What are 5 factors that determine your insurance premium? ›

Common factors include:
  • Driving record. ...
  • Garaging of the vehicle. ...
  • Gender and age of drivers. ...
  • Marital status. ...
  • Prior insurance coverage. ...
  • Miles driven and use of vehicle. ...
  • Make and Model of vehicle. ...
  • Licensed drivers in your household.

What should a consumer consider when deciding whether to purchase health insurance brainly? ›

When deciding whether to purchase a new insurance policy, a consumer should consider whether its potential benefits are worth more than its premiums over time. This means evaluating the coverage provided by the policy and comparing it to the cost of the premiums.

What are some important factors to consider when selecting the right insurance policy for your specific needs? ›

Assess your current financial situation

When assessing your current financial situation, consider your current assets and liabilities as well as your income and expenses. This will give you a clear perspective on how much coverage you need in case of emergencies.

What are the factors that are considered before making buying decisions of life insurance? ›

Your Life Cover Need

Future financial goals of the family. Present household needs – monthly kitchen expenses, kid's school fees, Future household needs – home renovation, major repairs and modifications. Financial needs of the family – health insurance cover, life insurance for spouse.

What is considered to be the primary reason for buying health insurance? ›

The main reason why health insurance is important is it helps you get the care you need—even if it's basic preventive care—at a price you can afford.

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