Which health insurance plan might be right for you?

Everyone loves a good deal, and health insurance bargains abound this time of year. But buyers should look beyond price when looking for a plan.

Shoppers should also consider doctor networks and coverage limits to avoid being saddled with large after-care bills.

Millions of Americans are now looking for 2025 coverage at annual sign-up windows Medicare Advantage plans and personal insurance. Plus, many employers They also tell their employees about their insurance plans for the next year.

Insurers selling Medicare Advantage plans are offering reduced coverage with $0 premiums, and individual insurance marketplaces created through the Affordable Care Act are offering tax credits to help with the cost of premiums or coverage.

Here are other factors to consider beyond price.

What is exemption?

This is the annual amount a patient pays for many covered services before the insurer begins paying part of the bill. Low-premium plans may offer deductibles of over $1,000 for individuals and several thousand dollars for families.

Shoppers should look at the size of the individual discount and understand where it applies. Regular visits to a specialist can lead to some hefty patient bills.

Deductibles are different from contributions or co-payments. These are fixed amounts that a patient pays for an insured service or doctor visit. Copays are generally not included in paying the deductible.

Are my doctors insured?

Insurers create networks of covered doctors and health systems. Some plans may not cover care sought outside of these networks.

federal government Website to find insurance plans St. Emily Bremer, president of St. Louis-based independent insurance agency The Bremer Group, said it makes it easier to filter covered doctors and hospitals when looking for a plan.

Bremer says shoppers need to consider more than whether their doctor recommends waxing. They should also consider which hospital system they would want to visit if a major emergency occurred.

What about prescriptions?

Insurance plans come with formularies or lists of covered drugs that vary by plan. These lists often group medications into tiers with different costs for the patient.

Shoppers should check how a plan will cover the regular prescriptions they currently receive.

Don’t immediately ignore the plan if the bill is too high. Help may be available. Drug manufacturers often have coupon or rebate programs that can cover patient costs as long as there is coverage for the drug, Bremer said. Websites like GoodRx may also be an option to get a price discount.

“If you buy a lot of supplies and see a lot of doctors, it can be really hard to find a perfect plan that will cover everything,” he said. “Sometimes you have to choose.”

What is coinsurance?

This is the portion of the bill for which the patient is responsible after meeting the deductible. This is a percentage that may change. Generally, plans with lower premiums offer patients greater financial security.

Coinsurance payouts can be damaging, so it’s important to know the percentage and risk you face.

For example, a cesarean birth can generate a bill of $25,000. A patient responsible for a $1,000 deductible and then 20% of the remaining bill could pay $5,800 of that total.

“Most people will focus on the exemption and forget about financial security, they shouldn’t do that,” Bremer said. “(He) can really sneak up on you when you have a big bet.”

Low-income individuals may qualify for assistance with some of these out-of-pocket expenses through cost-sharing discounts available in the ACA marketplaces.

What are the limits?

Health insurers will begin picking up the full cost of covered in-network care once you reach a plan’s out-of-pocket maximum for patient expenses. This may change depending on the plan.

For coverage sold in the ACA marketplace, this annual maximum amount cannot be more than $9,200 for individuals and $18,400 for families. next year.

Those who reach this level of spending may see only temporary relief. Patient expense totals included in the out-of-pocket maximum generally reset at the beginning of each calendar year or if you change plans during the year.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Education Media Group. AP is solely responsible for all content.