Which Plan Is Right for Me?
There's no one "best" health plan. The best plan is the one that fits your life. Let's look at a few common situations. See which one sounds most like you.
"I'm healthy and rarely see a doctor."
Consider: an HDHP with an HSA.
You'll pay less each month. Your checkups are usually still covered. And you can save the money you don't spend in a Health Savings Account (HSA), tax-free. Just make sure you can cover your deductible if something unexpected happens.
“I’m happy with a main doctor and the doctors near me.”
Consider: an HMO.
With an HMO, you pick a main doctor who coordinates your care, and you stay in the plan’s network. You’ll need a referral to see specialists. In return, HMOs often have smaller copays. If your doctors are in the network, it can be a good fit. Check the deductible too, since an HMO can also be an HDHP.
"I have a health condition and see specialists often."
Consider: a PPO or a plan with a low deductible.
If you get a lot of care, you'll likely reach your deductible every year. A plan with a higher monthly cost but lower deductible might cost less overall. A PPO also lets you see specialists without a referral. Check that your doctors and medicines are covered.
"My family lives in different places."
Consider: a PPO.
If you travel a lot, or your kids go to college far away, a PPO usually covers care in more places.
"We're having a baby or planning a surgery."
Consider: comparing your worst-case year.
You'll probably hit your out-of-pocket maximum. For each plan, add up a year of premiums plus the out-of-pocket max. Pick the plan with the lower total. Sometimes that's an HDHP, especially if your employer adds money to your HSA. Sometimes it's not.
Quick guide
Healthy, few doctor visits: HDHP with an HSA
Happy with local doctors and a main-doctor setup: HMO
Ongoing condition, many specialist visits: PPO or low-deductible plan
Family spread across states: PPO
Big medical event coming: Whichever plan has the lowest worst-case total
Meet the Garcias
The Garcias have two young kids who get sick a lot, and they like their kids’ doctor, who is in an HMO’s network. Last year they had 12 visits. The HMO had a higher monthly premium than the HDHP, but its low copays kept each visit cheap. When they added it all up, the HMO cost them less.
Three questions to ask yourself
How much care did I use last year?
Are my doctors and medicines covered?
Could I pay my deductible if I had to?
Key takeaways
The best plan depends on your health, budget and doctors.
Healthy people often save with an HDHP. People who need a lot of care may save with a lower deductible.
When in doubt, compare your worst-case year for each plan.
