Analyze Your Usage
Before buying a plan, look at your last 12 months of medical spending.
- Drug Costs: How much do you spend monthly on prescriptions?
- Dental Needs: Do you just need checkups, or do you need a root canal?
- Therapy: Do you visit a chiropractor or massage therapist regularly?
Key Plan Features to Compare
1. Co-Insurance Percentage
This is the portion of the bill the insurer pays.
- Standard: 70% or 80%. (e.g., For a $100 bill, they pay $80, you pay $20).
- Premium: Some plans rise to 100% coverage after a few years.
2. Annual Maximums
Most individual plans have a "cap" on how much they will pay per year.
- Example: drug coverage might be capped at $2,000 per year. If your medication costs $5,000/year, the plan might not be worth the premium.
3. Dental Recall Frequency
Check how often the plan covers checkups (scaling/polishing).
- 6 Months: Standard for good dental health.
- 9 Months: Common in cheaper plans.
4. Sliding Scales
Many plans increase coverage the longer you stay. Year 1 might cover 70%, Year 2 covers 80%, and Year 3 covers 90%. Patience pays off.