I recently spent a few hours analyzing healthcare options for my family and I thought it would be helpful to share my thought process. The insurance quotes below are actual numbers for my 2024 family plan (no income-based subsidies). Being self-employed, I use the NY State of Health Plan Marketplace to determine the best coverage that fits my family's needs.
Step 1 - Determine How Much Healthcare You Really Need
First, look at how much coverage is needed. If you only go to the doctors a few times a year, having a "Cadillac" healthcare plan may not make sense because you will pay far more in premiums than needed. On the other hand, if there are major medical expenses, it could make sense to have more comprehensive coverage. The Health Care Exchange categorizes plans by different medal levels (bronze, silver, gold, platinum) to help simplify the selection based on how much coverage is needed.
My family is fortunate that we do not have any recurring prescriptions or specialized care needed. For us, health insurance is a backup in case anything goes wrong and we need significant medical care. Without major ongoing costs, my goal was to get a Bronze level plan that also allows us to contribute to a Health Savings Account (HSA) for future healthcare needs on a pre-tax basis. Bronze-level plans have some of the least expensive monthly premiums (of the medal classifications) but also have higher deductibles and other limitations on coverage.
Step 2 - Compare Providers
After narrowing down the level of coverage needed, it is time to compare providers. In the Syracuse area, there are three main providers with several different plans each. It is not necessarily an efficient pricing market, so you shouldn't just compare on price or brand name.
Without having to compare prescription costs, our main concern is whether our current primary care doctors and pediatrician were covered in the plan, as well as the major hospitals in the Syracuse and Rochester areas. We do not travel or spend time outside of the state for routine healthcare, so we could look for a NY State-centered plan vs. a more national coverage option.
Step 3 - Compare Costs vs. Expected Needs
With a good understanding of what each plan type provides, we were able to select a provider and plan. We wanted an HSA-eligible plan which narrowed down the options further. There were two different plan providers that met most of all of our needs, however, one was only NY provider-based (HMO) and one had a more national network (EPO). The cost difference to have the national coverage did not make sense for us. Any emergency is covered by the plans and we only see (or plan to see) doctors in NY State.
Plan 1 Option - $1,851/month Bronze Plan HSA Eligible (my family's current plan, but the rates went up dramatically between 2023 and 2024).
Plan 2 Option - $1,296/month Bronze Plan HSA Eligible
Step 4 - Select Plan
After weighing the costs vs. benefits of each plan, we decided to make a switch to the less expensive plan that meets virtually all of our needs. For our family, the savings of $475/month ($5,700/year!) was impossible to ignore. All our current providers are part of the plan, emergencies are covered with excellent hospitals and risk beyond that we are willing to retain.
This savings example may be higher than others may experience for health insurance premiums, but I hope it illustrates the importance of spending some time looking at all available benefit options this year.
Every insurance plan has its benefits and drawbacks, but it is important for people to make informed choices about which risks they want to insure, and which risks they want to retain. In my situation, I believe the cost savings of the new plan are worth the risks I am retaining. However, everyone’s situation is different. Even if you do not end up switching your health plan, it is worth the time spent to have a better understanding of your coverage.