Picking the right health insurance plan is a deeply personal—and sometimes overwhelming—choice. Whether Open Enrollment has rolled around again or life changes have made you rethink your coverage, we’re here with insights and tips on how to choose the best plan for you (with the help of a few fictional friends). Depending on your health needs and cost preferences, some plans are a better fit than others.

Maybe you want the lowest possible monthly premium and don’t mind if you pay more for office visits—or maybe you’d rather pay more monthly to ensure your office visits are always covered by a copay. Knowing your priorities can make it easier to find the best choice for you. (Curious about how insurance works at Tia and which plans are in-network? We’ve got you.)

Meet Carly, Bea & Alice

Carly, Bea, and Alice work at XYZ Marketing Company, and are choosing next year’s insurance plan during Open Enrollment. XYZ Marketing Company is offering three insurance plans through A+ Insurance: the Gold PPO 2000, Gold PPO 1000, and HDHP 5000. Let’s break down each plan and see which works best for Carly, Bea, and Alice’s unique needs.

Overview of A+ Insurance plans offered by XYZ Marketing

1. Gold PPO 2000
   • Description: A deductible-based plan where all office visits and procedures count toward the deductible before insurance kicks in (no copays).
   • Premium: $100/month (low premium)
   • Deductible: $2,000
   • Best for: Those looking for a lower monthly premium and expecting minimal office visits or procedures.
2. Gold PPO 1000
   • Description: Offers a $1,000 deductible, but office visits are covered by fixed copays ($50 for primary care, $75 for specialists).
   • Premium: $200/month (higher premium)
   • Deductible: $1,000
   • Best for: Those expecting to have frequent doctor’s appointments and seeking a balance between lower out-of-pocket costs and premium payments.
3. HDHP 5000
   • Description: A high deductible health plan (HDHP) with no copays; all costs go toward the deductible, and coverage is more limited (e.g., no acupuncture, fertility treatments).
   • Premium: $50/month (lowest premium)
   • Deductible: $5,000
   • Best for: Healthy individuals who don’t anticipate needing regular care beyond preventive services and want a low-cost plan.

Carly’s focus: prioritizing preventive care with minimal office visits

• Healthcare needs: Carly is rarely sick and doesn’t expect to need frequent medical care, but wants to stay prepared in case of emergencies. She’s also focused on maintaining her health through preventive care.
• Plan chosen: HDHP 5000
  • Carly’s reasoning:
    • Carly isn’t expecting many doctor visits but wants to make sure her preventive care is covered, which the HDHP 5000 plan offers.
    • The lower premium of $50/month works well with Carly’s budget, and she’s comfortable with the higher $5,000 deductible since she rarely needs medical attention.
    • Carly’s focus is on saving money while still ensuring she’s protected in case of emergencies.
  • Plan benefits for Carly:
    • Full coverage for preventive services without needing to meet the deductible.
    • Lower monthly premiums that allow her to save more.
    • Out-of-pocket costs are manageable because Carly doesn’t foresee major medical expenses.

Bea’s focus: managing PCOS & planning for ongoing healthcare

• Healthcare needs: Bea was recently diagnosed with PCOS and needs regular doctor visits, lab work, and fertility consultations. She expects to have more frequent healthcare needs throughout the year.
• Plan Chosen: Gold PPO 1000.
  • Bea’s reasoning:
    • The $1,000 deductible is manageable, and she likes having fixed copays for office visits ($50 for primary care, $75 for specialists), which helps her budget for more frequent appointments.
    • She anticipates needing frequent lab work, office visits, and fertility consultations, and the Gold PPO 1000 plan covers more of these costs than the other options.
    • Although the monthly premium is higher ($200/month), Bea values knowing her office visits will be affordable when she needs them.
  • Plan benefits for Bea:
    • Lower out-of-pocket costs for office visits and specialist appointments.
    • Greater financial predictability for ongoing healthcare and lab work.
    • Peace of mind knowing her PCOS treatments will be more easily covered.

Alice’s focus: managing low back pain with acupuncture

• Healthcare needs: Alice has lingering back pain from a car accident and is exploring alternative treatments like acupuncture. She’s not often sick, but she wants coverage for complementary therapies.
• Plan Chosen: Gold PPO 2000.
  • Alice’s reasoning:
    • The $100/month premium is a middle ground for her budget, and while she’s okay with a higher deductible of $2,000, she prioritizes coverage for acupuncture, which isn’t offered under the HDHP 5000.
    • She doesn’t need frequent medical visits, but when she does, she wants the flexibility to access specialists like acupuncturists without breaking the bank.
    • The plan strikes a balance between affordability and access to the treatments she needs most, like acupuncture.
  • Plan benefits for Alice:
    • Lower monthly premiums while still offering access to acupuncture services.
    • Flexibility to meet her back pain management needs without frequent doctor visits.
    • The higher deductible works for Alice since she doesn’t expect to meet it often, but she’s comfortable with paying out of pocket for more expensive visits when needed.

Choosing an insurance plan based on your needs

As Carly, Alice, and Bea showed, there’s no one-size-fits-all solution to picking a plan: you need insurance that works for your specific financial and healthcare needs. A few things to consider:

• Are you more focused on preventive care or managing a chronic condition?
• Do you prefer lower monthly premiums with potentially higher out-of-pocket costs vs. a higher premium that offers more predictable expenses?
• Are alternative services like acupuncture or fertility treatments important to you? If so, ensure your chosen plan covers those services.

When you set aside time to think about your medical history, anticipated healthcare needs for the coming year, and your comfort level with financial commitments, you’ll be empowered to make the best decision—for your health and your budget.

Make the right choice for Open Enrollment

When Open Enrollment season rolls around, it’s the time to compare plans, reflect on your priorities, and ask questions. By making a thoughtful choice, you can get coverage that fits your life and keeps you healthy—today, tomorrow, and many years from now.