Four Things To Compare When Deciding on Health Insurance

For more guides on healthcare costs and coverage, check out Health Insurance + Type 1 Diabetes.

Picking out a health insurance plan can be overwhelming. There are many different terms, numbers and costs to wade through to figure out what each plan offers—and what it will cost you. 

When you live with diabetes, medications, diabetes equipment, doctor’s appointments and regular tests or treatment can be a lot to juggle–and come at a high expense. 

If you have choices for your health insurance, it’s important to consider what a policy covers (and how) to make sure it meets your unique healthcare needs. After all, health insurance should make it easier for you to access and afford the healthcare you need—however, that isn’t always the case! 

We’re here to help you narrow down your options, with a few key things you should compare when picking out a health plan.   

Comparing deductibles, premiums and copays

You’ll see many different costs, percentages and numbers included with each plan and it’s important to know what each one means—and how they’ll all work together to cover your health costs (or not). It’s not as simple as just choosing the one with the lowest monthly fee, because many things funnel into what your total health costs will be. And when you’re selecting healthcare coverage, it’s helpful to consider what that total healthcare cost will be—including your monthly bill.

Here’s a quick breakdown of the main health costs you’ll see included with each plan:

•       Monthly premium, or how much you will pay for health insurance each month (aka your monthly bill).
•       Deductible, or the amount you need to pay out-of-pocket before your health plan will kick in to cover more expenses.
•       Copayments and coinsurance, or the amount you’ll pay for each medical visit. Copayments are set dollar amounts and coinsurance is a percentage of the bill. With certain services, this takes effect immediately and with others, it kicks in after you meet your deductible. Often things like preventative healthcare services are covered before you meet your deductible—but check with each plan for specifics.   
•       Out-of-pocket-maximum, or the maximum amount you can pay for healthcare in a single year before your provider covers the rest.

Generally, plans with lower premiums will come with higher deductibles and a higher cost of care. Whereas, plans with higher monthly fees usually cover more and have lower deductibles—so they start covering more health expenses sooner.

To consider the best plan for you, tally up your regular health expenses—including doctor visits, medical supplies and prescriptions. If you’re managing a chronic condition like diabetes, it’s likely your annual health expenses add up and a higher premium will be the best bet for you.  You’ll have a higher premium, but a lower deductible and cost of care—and it will likely save you money in the long run since your total annual costs will be lower. A higher deductible plan will mean you’re footing the bill for many more health expenses before your provider chips in—and if you know you’ll have a lot of health expenses, this can be a pricey option.

To hone in on the best plan for you, look for the “summary of benefits” for each plan—which will spell out the basics of each plan’s costs and coverage. Compare the costs of your predictable expenses from plan-to-plan, by looking at things like:

• Is your primary diabetes care provider a PCP or a specialist? The co-pay will likely be different depending on whether they’re a specialist or PCP, and each plan may cover these at a different rate.
• How many doctor visits will you need? Do you have multiple providers for different health needs? Do you regularly use mental health services? How does that add up under each plan? The summary of benefits will list out the different copays and coinsurance for each category so you can get a good sense of what’s covered and what the cost will be for you. 
• Did you have any unexpected hospitalizations over the last few years? You can compare how each plan covers hospital stays and emergency services.
• Do you need regular blood work or tests? Check and see how routine testing is covered.
• What medical supplies and prescriptions do you need and are they covered under the plan’s formulary? (More on that below). 

Are your favorite providers in-network?

Do you have a favorite doctor? Is your go-to your primary care provider or endocrinologist for your diabetes care? A great way to start whittling down health insurance options is to see which plans include your go-to physicians as in-network providers. If they do, more of your health costs will be covered and you can avoid having to file claims for reimbursement to your insurance provider for out-of-network services. You can usually find a provider directory through each plan—or call your doctor directly to find out which health insurance they accept.

Will your prescriptions and medical supplies be covered?

It’s likely that you’re well aware of what prescriptions and medical supplies you’ll need to treat your diabetes over the course of a year–and this is great information to use when you’re shopping for health plans because different providers will cover these things at different rates. To start, think about your annual medical needs: What are the costs of your preferred CGM, insulins and other medications? What frequency do you need medical supplies and prescriptions? Do you need to change or replace your insulin delivery system next year? 

You can check and see which health insurance will cover your expected expenses at the best rate. You can often find this information in the plan’s summary of benefits and coverage or the formulary section, but you may need to call to ask about specifics for diabetes services and supplies like insulin, test strips and meters. Things like insulin delivery systems are probably covered under “durable medical equipment.” Look into whether the frequency of each medical need is limited and how much your copayment or coinsurance will be for each service and supply. This will give you a great idea of what your annual costs for each medical supply will be under each plan. 

Check the fine print

It’s a good idea to compare health plans to make sure your specific health needs are covered—–and you may want to call the different health providers to ensure they cover the supplies you need to manage your diabetes and clarify what you can expect to pay out of pocket. 

Some health insurance plans, like Medicare, cover the insulin you use with a traditional insulin pump differently than other insulin delivery systems. It may be helpful to find out how your preferred insulin is covered (like a pharmacy drug or durable medical equipment and supplies) and whether it depends on how you use it.