Choosing a health plan | How to choose a health plan | Health Tradition

Choosing a health plan

What to look for as you compare your Health Tradition choices

Individual and family health plans will not be offered for 2018. You may find a plan on healthcare.gov or you may qualify for a small group plan. Learn more.

Each health plan balances planned care and additional care in a different way. When choosing a health plan, start with what kind of care you think you will need.

Planned care

100% of recommended preventive and wellness services are included, no matter which plan you choose.

  • Annual physical exam 
  • Annual vision exam
  • Annual hearing exam 
  • Preventive screenings and immunizations recommended for your age and gender—from childhood immunizations to mammograms
  • The Mayo Clinic Tobacco Quitline program

Additional care

Next, think about what you are likely to need in addition to preventive care, and the limits on your ability to pay for care on your own in case of an accident or severe illness.

  • If you are in excellent health, concerned only about large, unexpected medical bills and you want to keep premium low, a plan with a higher deductible may be a good choice.
  • If you are under age 30, consider the Bronze Essential, our lowest-cost plan.
  • Have kids? Illnesses and mishaps are part of childhood. One plan has three extra primary care visits built in.
  • Do you take prescriptions? One plans has a separate drug deductible with only a copay after it is met. 

How cost-sharing works

Cost-sharing (how medical costs are split between you and us) varies with each plan, based on these elements:

Deductible
After preventive care, the next expenses are up to you until you meet your deductible. That’s when your plan steps in.

  • Choosing a higher deductible generally means you don’t expect to need much care.
  • Choosing a qualified high deductible plan (HD) gives you some additional cost-saving options.
  • All our plans begin paying for a family member as soon as that person meets the individual deductible—even before the family deductible is met.

Coinsurance
After you meet your deductible, the plan begins to pay the percentage determined by your coinsurance.

  • Coinsurance is anywhere from 50% to 100%, depending on the plan.

Copay
The amount you would pay at each provider visit is called a copay.

  • Some plans have copays, some have coinsurance, and some have both.

Maximum out-of-pocket
Adding up all deductible, copay and coinsurance, this is the most your covered services can cost you.

  • Sometimes, the deductible is the same as the maximum out-of-pocket. If so, covered expenses after the deductible are paid at 100%.

The monthly premium

You may want to save this part of the decision for last, because most people who buy individual insurance qualify to receive cost assistance. This can save you quite a bit. You would apply for premium reduction as part of enrollment (if you enroll with help from an agent, or online at HealthCare.gov).

More about choosing a health plan, at our direct enrollment website
Learn about cost reduction