How to choose a health plan for your stage in life

Tips from our experts to select the coverage you need without spending more than you have to.

A recent study at a Fortune 100 company showed 4 out of 5 employees picked a health insurance plan that didn’t end up matching what they needed that year.

How do you choose a plan that fits your life? As one of the largest employers in Minnesota, we asked our expert benefits managers Susan Bernardy and Natalie McKliget for some advice.

Now pick your stage in life and read on.

What’s your stage? 

  1. I'm young and/or single
  2. I'm getting married
  3. I'm expecting (or expecting to be expecting)
  4. I have children at home (and/or away at college)
  5. I am or will be an empty nester
  6. I’m nearing retirement and considering Medicare


I'm young and/or single

5 key questions to guide your decision:
  1. Am I staying on my parent’s plan?
  2. How much do I want to pay?
  3. Can I tolerate the risk of having a high-deductible plan?
  4. How often will I see a doctor this year?
  5. Am I attached to particular doctors? 
To stay on your parent’s plan or head out on your own
It’s up to your parent, to a point. Current laws allow you to stay on or be added to your parent’s health insurance plan until you turn 26 years old – even if you’re attending school, living on your own, financially independent, married, or eligible for your own health plan at work. 

If it’s possible to stay on your parent’s plan, consider whether it’s more or less expensive for you to do so and whether your parent will expect you to contribute to the cost. Some family plans can be more per person than an individual plan. 

If your 26th birthday falls during your parent’s plan year, you’ll lose the coverage. You’ll be eligible to sign up for a new health plan when that happens, but consider whether you want to wait until then. 

The lowdown on premiums, deductibles, and what makes sense for you 
In general, Susan says, the plans with the lowest premiums (your price to purchase a health plan, typically paid out of your paycheck) have the highest deductibles (what you pay for medical expenses before the plan starts to cover your costs). 

“Our youngest employees often say, ‘I don't use health care that much. I just need preventive care, so I'm going to pick that higher deductible plan because it's the cheapest for me,’” Susan says. “But I tell them that it’s only going to be the cheapest until they incur expenses. Contributing to a health savings account helps them cover unexpected costs and save for future expenses.”

With a high-deductible plan, you need to consider whether you can risk covering the entirety of the deductible in one bill. If you have an emergency expense or are hospitalized before you meet your deductible, you’ll likely be responsible for thousands of dollars in medical bills all at once. For a young person with little savings or a single person without a partner’s income to count on, that may be difficult. 

Bottom line, calculate the cost of the premiums plus the deductible for each plan you can choose from. A high-deductible plan might have a lower overall cost for the year than a plan with higher premiums, because you have to pay the premiums no matter how little you use your insurance. But you have to be willing to take the risk of getting a big bill up front. 

The doctors you want to be able to see
Most plans have a set of doctors and specialists that are “in network.” It will cost less for you to see them, and some plans have little or no “out-of-network" coverage. 

If you’re healthy, you may not have established a relationship with a particular doctor yet or be concerned where you get care. 

But if you’re sick often, want to keep seeing a particular gynecologist for your birth control, or have a preference for where you could get care in the case of an injury, check out which doctors from local health systems are in network. 

You could also elect an “open access plan” that allows you to go to any doctor you choose, though those plans often cost more. 

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them.


I'm getting married 

5 key questions to guide your decision:
  1. Is my doctor, and my partner’s doctor, in the network? 
  2. What are the benefits and drawbacks to combining plans now?
  3. How much do we want to pay in premiums?
  4. Can we tolerate the risk of having a high-deductible plan?
  5. How often will we see a doctor in a typical year? 
Saying ‘I do’ could mean choosing a new doctor 
Assuming you both have a doctor, you’ll need to learn whether the plans offered to you include those doctors. Doctors that are “in network” cost less for you to see. If you and your partner’s preferred providers aren’t in the same network, you have a choice to make:
  • You could keep your individual plans. 
  • One of you could switch to an in-network provider on your partner’s plan. 
  • You may be able to elect a plan that gives both of you access to any doctor you choose — though often at a higher cost. 
Tying the knot could mean moving to a family deductible 
In general, Susan says, the plans with the lowest premiums (your price to purchase a health plan, typically paid out of your paycheck) have the highest deductibles (what you pay for medical expenses before the plan starts to cover your costs). This is true for family plans as well as individual plans.

Some family plans have the same premium and deductible whether you have two people or 10 in your family. If your family is just the two of you and your company doesn’t have lower rates for smaller families, you should calculate whether it’s cheaper for the two of you to stay on two individual plans. 

If you’re considering a high-deductible plan as a couple, you’ll need to weigh the risk of covering the entirety of a family-level deductible if it came in one bill. If you or your partner have an emergency expense or are hospitalized before you meet your deductible, you may be responsible for thousands of dollars in medical bills all at once. For newlyweds with little savings, this may be difficult. It leads some couples to look at other plans, despite higher premiums.

“Are you going to be okay with a large medical bill?” asks Natalie. “I see a lot of hesitation enrolling in high-deductible plans because people are just scared of that ‘What if?’ piece. Once you have to meet that family deductible, as opposed to an individual deductible, it can get cost-prohibitive for people. That’s when people may look for plans with co-pays or low deductibles.” 

‘In sickness and in health’ means finding the coverage you both need
To find the best value, Natalie and Susan advise people to look at their predictable health care expenses, based on what they spent last year or what they know is coming up in the year ahead. 

If you’re going to select a combined plan, you and your partner will need to understand each other’s unique health care needs. 

If you or your partner have multiple prescriptions, it’s probably easier to predict your medical expenses for the year. You might also be able to predict if and when you’re likely to hit the combined deductible and out-of-pocket maximum — the total amount of medical expenses you’re responsible for during the year before the plan covers 100 percent.

Though these total amounts are higher with family plans than with individual plans, predicting these expenses allows you to understand which plan offers the most value. 

If you and your partner don’t have prescriptions or go to the doctor much, high-deductible plans can typically offer value through a health savings account (HSA). You can contribute money from your paycheck into that account pre-tax, which helps you save on your income tax. 

Some employers also contribute to your HSA, and you can either use that money to pay for expenses while meeting your deductible or keep letting it accumulate in the HSA for future medical expenses. 

Whether it’s your own contributions or your employer’s, money in that account is not “use it or lose it” within the plan year. 

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them. 


I'm expecting (or expecting to be expecting) 

5 key questions to guide your decision:
  1. Whose doctors are in the network?
  2. Are we willing to switch providers if some aren’t in the network? 
  3. How much do we want to pay in premiums?
  4. Are we willing to risk having a high-deductible plan as a family?
  5. How often will we see a doctor in a typical year? 
Who’s in the network matters more now
If you’re pregnant or planning a pregnancy, you may have already picked someone to deliver your baby, a hospital to deliver at on the big day, or a pediatrician. (Don’t have a doctor yet? Here are a few tips that can help.) 


Natalie says the first thing to learn is whether these providers are in the plan's network, because you’ll pay more if they’re not. Susan advises contacting the insurance company directly for the most accurate, updated list of doctors for specific plans.

You’ll have the best coverage if your doctors or midwife are in the plan’s network. Under current law, all prenatal services are fully covered if you stay in the network. Delivery at an in-network hospital will also give you the best benefit.

Another option is choosing an “open access” plan that lets you go to any doctor, though these plans often cost more. 

Whatever plan you choose, check to see if any of them have additional maternity benefits.

Your new family now has a family deductible
With your new baby you’ll need to move to a “family” health plan if you aren’t already on one. The definition of family varies from plan to plan. It could be you and one child. It could be you, your partner, and a number of children. Regardless of the plan, increasing the number of people covered may come at a higher cost. 

In general, Susan says, the plans with the lowest premiums (your price to purchase a health plan, typically paid out of your paycheck) have the highest deductibles (what you pay for medical expenses before the plan starts to cover your costs).

If you’re expecting, you know you’ll have many medical bills in the near future. High-deductible plans may provide more value in the long run, but the up-front cost may be too much for you to handle. 

“Once you have to meet that family deductible, as opposed to an individual deductible, it can get cost-prohibitive for people,” Natalie says. “That’s when people may look at plans with co-pays or low deductibles.” 

If you’re expecting a new child — whether it’s your first or your next — you can’t add the child to your coverage until after they’re born, but you can get ready beforehand by deciding which insurance coverage you and your family may need. It’s important to remember that once you add the baby to your coverage, your monthly premiums, deductibles, and out-of-pocket maximums may increase.  After the baby has been added to your coverage, the insurance company and the hospital will process the baby’s medical expenses back to the delivery date.

Your new baby isn’t the only one using your health plan
To find the best value in a health care plan, Natalie and Susan recommend looking at your predictable health care expenses for the coming year. You may not know what your new baby will need, but you probably know more when it comes to your own health.

“Some people question why they even have health insurance, because they never use it,” Natalie says. “Others know they've got 12 prescriptions to fill on a monthly basis.”

If you’re sick a lot or regularly take medication, look back over the past year to see how much you spent on medical expenses to predict how quickly you might hit the deductible for the different family plans available to you. The sooner you reach the deductible, the sooner your insurance kicks in, but you also have to consider the co-pays or co-insurance each plan may have for doctor visits and prescriptions. 

If you’re relatively healthy, high-deductible plans typically offer value through a health savings account (HSA). You can save some of your pre-tax income there for future medical expenses – an attractive feature to parents-to-be. Some employers may contribute to your HSA as well. 

In the end, predicting your expenses and comparing them to each plan’s potential costs and savings can help you make a good financial decision.

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them.


I have children at home (and/or in college)

5 key questions to guide your decision:

  1. Whose doctors are in the network?
  2. How will my child in college be covered?
  3. How much do we want to pay in premiums?
  4. Are we willing to risk having a high-deductible plan as a family?
  5. How often will we see a doctor in a typical year? 
A family doctor, or many doctors for your family
If you have children at home, you may have a family doctor or more than one doctor: a pediatrician for your kids and a primary care provider for yourself. You may even see some specialists. 

The first consideration in picking a plan, Natalie says, is to learn whether all of these providers will be in the plan’s network next year. Susan advises contacting the insurance company directly rather than the doctor’s office for the most accurate, updated network information. 

If one or more of your preferred providers won’t be in the plan’s network, you may be able to elect a plan that gives you access to any doctor you choose, though often at a higher cost, or think about switching to in-network providers. When a child is away from home but still covered under your health plan, you’ll want a network that includes doctors where they live or you’ll risk paying out-of-network prices if they get sick or injured. An “open access” plan may be the right option for you, especially if your child is going to college out of state. 

The risk of a family deductible
In general, Susan says, the plans with the lowest premiums (your price to purchase a health plan, typically paid out of your paycheck) have the highest deductibles (what you pay for medical expenses before the plan starts to cover your costs).

Low premiums make high-deductible plans attractive for some, particularly for people who rarely see a doctor. This assumes, however, that you or the kids won’t have a medical emergency or hospitalization. If you do, particularly early in a plan year, you may be responsible for the entire deductible – often thousands of dollars – all at once. 

High-deductible plans may provide more value in the long run, but the up-front cost may be too much, particularly for families. This leads some to look at other plans, despite higher premiums.

Matching coverage with your unique family needs 
To find the best value in a health plan, Natalie and Susan recommend looking at your predictable medical expenses for the coming year. Do your kids have allergies or asthma, get a lot of ear infections, play sports, or have other reasons they may end up at the doctor or emergency room? How often are you or your partner seeing a doctor? What do your medications cost?

In the end, taking the time to predict your expenses and compare them to each plan’s potential costs and savings can help you make a good financial decision. Especially with the complexity of a family, check out whether your employer or the insurance company has an online calculator that helps you assess your medical expenses.

“If people sat down and did the math, they can often save a lot of money and still experience the same high level of care,” Natalie says. “Most just don't realize which plan works in their favor financially.”

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them.


I am or will be an empty nester

5 key questions to guide your decision:
  1. Should I keep my child on my health plan?
  2. Are my doctors in the network?
  3. Will we be seeing a doctor more or less than before?
  4. Which plan provides the best value for my situation?
  5. Do I want to use a health savings account (HSA)?
To keep, or not keep, the kids on your health plan
If your child is under the age of 26, you can keep them on your health plan. But you’ll want to consider all the possibilities. 

Current law allows for children to remain on or be added to their parent’s health insurance plan until they turn 26. This can be helpful if your child is still in school. But let’s say your child is working and eligible for their own employer’s health plan. 

The law still allows you to keep them on your plan. But remember that individual plans have cheaper premiums, lower deductibles, and lower out-of-pocket maximums than family plans. Even if you’re willing to help with your child’s insurance costs, it could be cheaper collectively for you and your spouse to stay on one plan and have your child take the insurance from their employer. 

Assuming your children will no longer be on your health plan, your expenses will focus on your needs again. To find the best value in a health plan, Natalie and Susan recommend looking at your predictable medical expenses for the coming year. By now, you have a good idea about the services you use in a typical year. 

If you’re married and each of you has access to employer health plans, consider whether the services you need might be cheaper to get if the two of you go back to individual health plans. If you want to stay on a plan together, check whether one of your employers has an “employee + spouse” option, because that often has cheaper premiums than a family plan including children. 

How you can still see your doctors wherever life takes you 
At this stage of life, you’ve likely found a regular doctor you’ve gone to for years. You may have even been referred to a specialist or two. But you may also need medical care in more than one place.

To choose a plan, Natalie says, learn whether all of these providers will be in the plan’s network next year. Susan advises contacting the insurance company – not your doctor’s office — for the most accurate, updated network information. You’ll have the best coverage if your doctors are all in the plan’s network.  If one or more of your preferred providers aren’t, you could switch to in-network providers or consider an “open access” plan so you can go to any doctor you choose.

Though they often cost more, open access plans are helpful if you have a cabin up north, spend part of the winter out of state, or have a child on your plan who lives outside the area. 

Expensive plans may not be the best plan for you
At this stage, you probably aren’t just looking for the cheapest plan. You want great coverage as well. 

Even if you’re healthy now, you’re more likely at this stage to develop a chronic issue like high blood pressure, you’re more likely to need prescription medicines, and you may even be considering an elective procedure.

In general, Susan says, the plans with the highest premiums (your price to purchase a health plan, typically paid out of your paycheck) have the lowest deductibles (what you pay for medical expenses before the plan starts to cover your costs.)

While the most expensive plans may be seen as top of the line, it’s not always the best fit for you.

“Many still pick expensive plans because it's seen as the richest plan with the most coverage,” Susan notes. “But if they don't incur many expenses, what they’re paying in premiums for that low-deductible or co-pay plan is more than what they would pay out for a high-deductible plan by the end of the year. They're kind of over-insured.”

Knowing this, it’s important to calculate your expenses to decide which plan is right for you.

“If people sat down and did the math, they can often save a lot of money and still experience the same high level of care,” Natalie says. “Most just don't realize which plan works in their favor financially.”

Features that fit you 
Another thing to consider is the features of the plans themselves. 

While high-deductible plans come with lower premiums, they also come with the ability to use a health savings account (HSA), giving you a way to save pre-tax income for medical expenses beyond the plan year. 

With the kids on their own, many empty nesters use this as a way to supplement their retirement savings. The possibility of an employer contribution to the HSA can make that especially attractive for some people, because both your money and your employer’s contribution earns interest tax free. You may even have the option to invest a percentage of the funds. Check the details of your plan’s HSA to understand what’s offered and what’s required, and know that HSAs aren’t for everyone.

“Some people find dealing with an HSA or some other limited-purpose account too overwhelming,” Natalie says. “It's nothing they've done in the past, and they're not interested in going down that road.” 

The simplicity of co-pays, as opposed to the management of a personal HSA, is a benefit of other plans, typically with lower deductibles. While you’ll likely pay more for premiums and for each office visit, you’ll usually reach your deductible faster. 

While reaching the deductible feels like the end of medical bills for the year, it’s not always the case. 

If the plan has co-pays, you’ll pay a fixed amount for every doctor visit or trip to the emergency room even after you meet your deductible. Other plans have coinsurance — a percentage of the bill you have to pay yourself. Know what that percentage is, because 20 percent of a large medical bill could be substantial. 

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them. 


I’m nearing retirement/considering Medicare 

5 key questions to guide your decision:
  1. When do I want to sign up for Medicare?
  2. Are my doctors in the network?
  3. How often will I use services in a typical year? 
  4. Which plan provides the best value for my situation?
  5. Do I want to use a health savings account (HSA)?
What to do about Medicare
In most situations, you don’t need to sign up for Medicare when you’re 65 if you’re still covered by an employer-provided insurance plan. On the flip side, you could go on Medicare at age 65 even if you’re still working and still eligible for an employer plan. 

You can also have coverage through both your employer’s plan and Medicare. The two plans will undergo what’s called a coordination of benefits. This coordination will decide which plan pays for which services. Natalie says many people elect to enroll in Medicare Part A — which provides some hospital insurance — because it doesn’t typically require a monthly premium, but defer Medicare Part B – which provides medical and preventive service insurance — until retiring.

Compare the benefits and costs of all plans before committing to carrying two insurance plans to find the best fit for your situation.

Keeping your relationships with your doctors
At this stage of life, you’ve likely found a regular doctor you’ve seen for a long time and want to continue seeing. You may have a regular specialist or two as well. 

Most doctors take Medicare. If you’re sticking with an employer plan, you’ll have the best coverage if your doctors will all be in-network for the plans available to you. If one or more of your preferred providers aren’t in the network, you’ll have to weigh the financial savings of switching vs. the loss of convenience and the loss of your relationship with your providers.

You may be able to elect an open access plan that gives you access to any doctor. Though they often cost more, open access plans are helpful if you travel often, have a cabin up north, or spend the winter out of state. 

Expensive plans may not offer the best coverage for older adults
At this stage, you’re probably not just looking for the cheapest plan. You want great coverage as well. 

Many adults are living healthier longer. But no matter what your lifestyle, you will experience the natural effects of aging. You’re more likely to develop chronic conditions like high cholesterol, high blood pressure, or diabetes. You’re more likely to have multiple prescriptions. You’re more likely to need surgery such as a knee replacement. 

While the plan with the highest premium may seem to be top-of-the-line, it may not offer “better” coverage than other plans. The higher premium may have more to do with the size of the deductible and the other expenses you’re responsible for, like co-pays or co-insurance. You’ll also want to understand your total costs, including whether the prescription drug coverage in the plan is separate from the deductible or not. 

A high-deductible plan could be beneficial if you’re planning expensive surgery early in the plan year and will quickly reach your out-of-pocket maximum. High-deductible plans usually have lower premiums, and as soon as you reach your deductible and out-of-pocket maximum, your plan pays 100 percent of covered expenses for the rest of the year. 

The value of simplicity in the golden years
Other things to consider are the features of the plans themselves. 

High-deductible plans often come with the ability to use a health savings account (HSA), giving people who are not enrolled in Medicare a way to save pre-tax income for medical expenses beyond the plan year. If your medical expenses fluctuate from year to year, that extra money can help cushion you during a year when you’re sick a lot or have an unexpected procedure.

Many in this stage see HSAs as a way to supplement their retirement savings, especially if you’re already maxing out your 401K contribution. The possibility of an employer contribution to the HSA can make that especially attractive. If you don’t dip into the HSA for medical expenses while you’re working, your contributions and your employer’s contributions to the HSA go with you after you retire. With some HSAs, you may even have the option to invest a percentage of the funds. 

Even if you just want to leave the money in the account untouched for retirement, you still have to keep track of it just like you do other retirement accounts. Check the details of your plan’s HSA to understand what’s offered and what’s required, and know that HSAs aren’t for everyone. 
“Some people find dealing with an HSA or some other limited-purpose account too overwhelming,” Natalie says. “It's nothing they've done in the past, and they're not interested in going down that road.” 

The simplicity of co-pays or co-insurance, as opposed to the management of a personal HSA, is a benefit of other plans, typically with lower deductibles. Knowing all this, find the plan that matches what’s most important to you: cost, relationships with your doctor, saving for later, or the level of complexity you’re willing to take on.

Find a clinic or doctor near you, and check your insurance provider’s website to know which health plans include them.



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