Affordable Health Insurance Checklist: 5 financial factors to consider

by Enrollment USA September 19, 2015


Your budget is likely in the front of your mind if you are shopping for private health insurance. Wallet-conscious shoppers tend to zero in on the monthly payment alone, but there are many financial factors to consider when choosing a health plan.

Read on for five financial considerations that will help you find the best affordable health insurance for you and your family.

#1 Premiums
Premiums are probably the first thing you’ll check out when comparing health insurance plans. A premium is the amount you will pay each month for your health insurance coverage. Each insurer typically offers several levels of coverage with differing levels of benefits, which means there can be multiple premium options. As you’d suspect, plans that cover more of your medical expenses have higher premiums. 

Before selecting a health insurance plan, evaluate your budget to see how much you can realistically afford each month. Missing monthly premiums can disrupt the payment of claims or lead to termination of coverage, so you don’t want a plan that will break the bank. Also, some insurers require you to pay premiums on a quarterly or annual basis. If that’s the case with your plan, be sure you’re able to make the up-front payment.

#2 Covered Benefits
Under the Affordable Care Act, insurers are required to cover certain services, including preventative care. Preventative care services, like annual checkups, are covered 100% by the insurance company. (View the full list of preventative services here.) However, when comparing insurance plans, you need to consider expected medical needs that do not fall into this category.

Some people don’t use health care services often. For those individuals, a plan that covers only major medical expenses may make sense. But if someone that is on your policy takes frequent trips to the doctor’s office or needs maintenance medication, you may want to check out an insurance plan that offers lower deductibles and copays.

Additionally, if you are looking for a plan that offers a more extensive list of services such as chiropractics or other forms of alternative medicine, double-check that those services are covered before selecting your plan. Ask for a Summary of Benefits and Coverage for complete details on what your plan will—and won’t—pay for.

#3 Deductibles
A health insurance deductible is the amount you’ll have to pay for covered services (other than preventative care) before the health insurance kicks in. Let’s say, for example, that your insurance requires a $2500 deductible. This means that you will have to pay that $2500 before your health insurance provider will issue any payments. Some plans offer lower deductibles, but that typically means you will pay more each month for your premium.

For those individuals who are suffering from a chronic health condition or who require regular medical treatment, it often makes sense to pay a little more each month in premiums to avoid higher out-of-pocket expenses throughout the year. Those who do not anticipate costly medical expenses may find it financially smarter to choose a high-deductible health insurance plan. However, if you opt for a plan that requires a higher deductible, make sure you have the ability to pay it should serious a serious illness or injury arise.

#4 Copayments
Another out-of-pocket expense to consider when shopping for private health insurance is the plan’s copayment schedule. Copayments (or copays) are fixed amounts that you’ll pay for certain types of services. For example, you may have a $30 copay each time you visit your doctor, a $50 copay when you see a specialist, and a $100 copay when you visit the Emergency Room.

Different plans require different copays. Health insurance plans with higher premiums tend to have lower copays, while those with lower premiums typically require higher copays. There are even some health plans that don’t require copays at all. The frequency with which you seek medical care will likely determine which health insurance copay requirements are best suited for you and your budget.

#5 Providers
Each health insurance company has its own list of approved health care professionals, hospitals, and vendors who deliver services to their clients at negotiated rates. These are your plan’s preferred or in-network providers. Those professionals, hospitals, and vendors who are not on the health insurer’s preferred provider list are considered to be out of network and often require higher copays or are not covered at all.

When selecting the best insurance plan for your family, you’ll want to check to see if the health care providers you wish to use are covered. If you have an established relationship with your doctors—or you have a condition that requires you to see certain specialists— you’ll want to be sure they’re listed on the health insurance plan’s preferred provider list. You may also want to see if the hospital or clinic nearest to your home is in the plan’s network.

Enroll in Affordable Health Insurance Today!
Using a health insurance exchange like Enrollment USA is the best way to compare health insurance plans side by side. Our technology takes your preferences into account and then matches you with the right plan. We provide you with the information on premiums, providers, coverage, and out-of-pocket expenses for Utah’s top health insurers all in one convenient place so you can buy the affordable health insurance plan that’s best for you online through our site.

Start shopping for a health insurance plan now if you qualify for Special Enrollment or learn more at