Choosing an Individual & Family Health Plan
There's a lot to consider. Make the best decision for you and your health.
Things to consider before choosing a health plan
From your budget to your lifestyle and your health, here are some things to keep in mind when researching and comparing plans:
It’s important to find out if your doctors and other health practitioners are in a plan’s network before choosing that plan. You’ll typically pay quite a bit more if you visit an out-of-network provider.
Also check to see if any prescription medication you regularly take is on the plan's drug list, also known as the formulary.
Health plan companies, including UCare, offer care through broad and focused provider networks, though some only offer one or the other. A broad network gives you access to a wide variety of care systems and providers while a focused network requires you to see a more limited number of providers in exchange for lower premiums.
Review your health conditions to see what care you may need. If you're buying coverage for members of your family, be sure to consider these questions for them, too.
- Do you anticipate a test, procedure or major health expenses in the coming year?
- Do you have a chronic health condition that you manage with medication and/or with regular doctor visits?
Review your budget to see how much you can afford for premiums and expected medical care. This will help you determine which plan type and coverage level to choose.
- Are you taking advantage of expanded subsidies on MNsure to decrease your monthly premium and out-of-pocket costs? Recent changes in the Affordable Care Act broadens the ability to qualify for subsidies so even if you didn’t qualify, you now may. The average household is saving $560 each month in premiums so check mnsure.org to see if you qualify.
- Is it easier on your budget to have lower monthly premiums and pay more out of pocket when you receive care, or have higher monthly premiums in exchange for lower costs when you receive care?
- What is your ability to manage unexpected medical costs?
- Are you comfortable with a smaller, more focused provider network to save money on monthly premiums?
- Is having another way to save for retirement a priority? If so, consider an HSA–compatible health plan with an optional Health Savings Account.
Let’s say that Tori is a 33 year-old small business owner who lives in the Twin Cities area and purchases her own health coverage. Tori is generally healthy, going to her M Health Fairview doctor once a year for her annual exam and maybe a couple times per year for minor illnesses like strep throat. But this year Tori fractured her arm, so she took a trip to the Emergency Room (ER). To treat Tori’s simple fracture, she receives an x-ray, purchases crutches (durable medical equipment), and gets physical therapy (rehabilitation services). Because Tori is older than 30 years old, she is not eligible for a Core plan.
Here are estimates of what Tori’s costs would have been for her fracture under several UCare Individual & Family Plan scenarios using in-network providers:
Costs to treat a simple bone fracture
|*Monthly net premiums||$262.84||$272.84||$308.85||$344.24||$375.47||$268.43||$301.55|
|Plan overall deductible||$8,000||$5,900||$3,000||$2,000||$950||$7,500||$3,000|
|Depending on Tori’s plan, she will pay:|
|Total Tori would pay||$2,700||$2,700||$2,800||$2,200||$1,800||$2,800||$2,800|
*Premium reflected includes subsidies available through MNsure as well as pricing available in this region and network.