Health Insurance
Buyer’s Guide

New to health insurance? Start here.

You could lose an entire day, or a weekend even, trying to understand all the health plans out there. Take a look at our health insurance buyer’s guide. It will show you how to focus on what you need from your health plan, choose coverage that’s right for you, how to sign up, and more.

Health Insurance Buyers Guide

Step 1: Determine what kind of health insurance you will need.

There are different kinds coverage. In general, there is employer coverage, individual or family coverage and Medicare coverage. Most people get health insurance from their employer. People 65 and older are usually covered by Medicare. So, if you don’t get insurance from your employer and you don’t qualify for Medicare, you will be looking at getting individual insurance. You can get coverage for yourself only or cover your spouse and kids, too.

Step 2: Where can you purchase individual health insurance?

When purchasing individual health insurance, you have a couple of options. You can shop plans on your state’s Affordable Care Act marketplace, if avaialble. California’s state marketplace is CoveredCA. To find out whether or not your state has its own marketplace, go to and enter your zip code. You’ll be redirected to your state’s marketplace if it has one. If your state does not have its own exchange, you can use the federal marketplace instead. In order to receive premium assistance from the government based on your income, you must purchase coverage through the marketplace. Another avenue to obtain individual health insurance is going directly through the insurance carrier or using an insurance agent or broker.

We recommend using an agent or broker because they will be knowledgeable about the insurance carriers and plans available in your state. If certified with your state, they can get you a marketplace plan so you don’t miss out on potential premium assistance. Insurance carriers pay the agent/broker a commission, so there is no cost to you.

Step 3: What type of health plan is right for you?

Now, that you know you need individual health insurance and you know where to purchase it, how do you know which type of health plan is right for you? The most common types are HMOs, PPOs, EPOs, and POS plans. The one you select will determine your out-of-pocket costs, as well as which doctors you can see. For more detail on plan types, read our article, Comparing Health Insurance Plan Types.

While comparing plans, there are two documents which must be reviewed thoroughly before making a decision. The first one is called the Summary of Benefits (SOB). The insurance carrier usually has a link to the Summary of Benefits on their website. The SOB provides a snapshot of the plan’s benefits. It will list deductibles, co-pays and co-insurance amounts, as well as specific health care services and whether or not they covered,and at what level. The Summary of Benefits will also have prescription drug coverage details. The second document you need is the plan’s Provider Directory. This document lists the doctors and hospitals that participate in the plan’s network. If you want to see a specific doctor, this directory will confirm whether or not they will be in-network or out-of-network.

Step 4: Compare plan benefits

At this point, you should be considering a few health plans. Now, compare the benefits a little closer. If you want to see a specific doctor, confirm they are “in-network”. Or if you need to see a chiropractor, compare the out-of-pocket costs of each plan. Are you expecting a baby or planning on having baby? Do you frequently need emergency care? Or are you taking a specific brand medication? These are just some things to consider when comparing benefits to help you tailor a plan to your needs.

Step 5: Repeat Step 4, seriously. Make sure you aren’t missing anything.

Skipping this step could mean missing out on a plan that is much more suited to you and your family’s health needs.

Step 6: Summary

While we know that our guide can’t answer all your questions, we do think it will help you make the right decisions for yourself or your family. If you still have questions, don’t hesitate to give us a call. Remember, a plan with low monthly premiums will generally have higher out-of-pocket costs, and vice-versa. The lower premium plans are best suited for those in good health and rarely see a doctor or simply can’t afford the premium of a lower out-of-pocket costs plan. Having insurance is better than not having it all.

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