When you shop for health insurance plans and services, it's a good idea to consider certain things. The more you know ahead of time, the better. Learning about everything from networks and premiums to copays and coinsurance can help you get a plan that meets your needs.
What to look for when shopping for health insurance
Buying health insurance is easy when you have a knowledgeable team to support you. We are here to simplify health insurance and help you:
- Know which providers are in-network.
Many health plans offer in-network providers. Members pay less to use these providers. Choose a plan that gives you in-network access to the doctors and hospitals you want. You will likely have to pay more toward your care if you see a provider that’s not considered in-network.
- Look beyond the premium.
A premium is the amount you pay your insurer each month to keep your health insurance. It is a good idea to consider your potential out-of-pocket costs too. These are costs that you pay for, not the health plan. These can include things like copays and coinsurance.
- Weigh premium versus deductible.
When you compare health plans, think about striking the right balance. A plan with a lower premium will likely have a higher deductible.
- If you use your plan often, you may want a plan with a lower deductible.
- If you don't use your plan often, you should consider one with a lower monthly premium.
- Know what your deductible is. A deductible is the dollar amount you must pay out-of-pocket for medical expenses before your health plan begins to pay for them.
- Consider copayments (copays). A copay is the amount you pay out-of-pocket when you go to a doctor or health specialist. It is on top of what you pay for your premium.
- Understand coinsurance. Coinsurance is the amount of a medical bill that you must pay after you meet your deductible.
Questions to ask when buying medical insurance
How often will you need medical care?
Your plan will likely cover many medical expenses before you reach your deductible. That's why you should consider how much and what types of care you could need during the plan year. If you might have a larger expense, like surgery, factor that into your decision.
Do you have health care providers that you see regularly?
Getting care from the doctors and hospitals you trust is important. When you are shopping for a plan, research providers before you make your decision. Make sure the providers you want to see are in-network for the plan you are considering.
Have you been prescribed any medications?
If you take any prescription medications, make sure they are included in the formulary for the plan you are considering. Research your medications before you choose a plan so you can make an informed decision.
Do you have any major health concerns?
If you have a health condition that requires a lot of care—meaning you go to the doctor often or need other services to help you manage a health condition—a plan with a lower deductible could provide the best value for you. If you think this might be the case for you, remember to consider these costs:
- Copay: This is the amount you pay out-of-pocket when you go to a doctor or health specialist. It is on top of what you pay for your premium. You generally have a lower copay when you use an in-network provider.
- Coinsurance. This is the amount of a medical bill that you must pay after you meet your deductible. If your coinsurance is 20 percent, you must pay 20 percent of the cost of your covered services. Your health plan will pay 80 percent of the cost. Plans with low monthly premiums often have higher coinsurance, and plans with higher monthly premiums often have lower coinsurance.
How to find the right health insurance
With UPMC Health Plan, it’s easy to find and buy a medical insurance plan that fits your needs. You can shop during the Open Enrollment period or during a special enrollment period if you’ve experienced a qualifying event.
Use our shopping tool to find the right plan for you. Here's how:
- Tell us who needs insurance. Are you shopping just for yourself, or do you want to include other family members? Some additional basic information can help us further streamline your results.
- Find out if you qualify for financial assistance. Our calculator can show how likely you are to qualify for financial assistance* to pay for your health insurance plan.
- When you see your results, you can choose whether to shop on Pennie®, Pennsylvania's health insurance marketplace—or continue shopping with UPMC Health Plan.
- Add some details for each person you want to include on your plan.
That's it! We'll narrow down the plans based on what you told us. You can always choose to see every plan.
Looking for shopping assistance? You can schedule an in-person or virtual appointment with one of our Connect Centers to get one-on-one enrollment help.
Let's go shopping!
UPMC Health Plan products can also be found on pennie.com.
*Eligibility for financial assistance is based on annual adjusted gross income. Annual income amounts are determined by the federal government. To determine your eligibility for financial assistance, you must confirm your eligibility on the Pennie website.