How To Make Sense Of Health Insurance Plans

In today’s day and age, it can be tough to find quality health care. With so many options to choose from, where should you even start? While finding quality health insurance is enough of a challenge itself, how do you find affordable health insurance as well? Well, we are here to help. We will walk you through some tips to finding quality, affordable health care, and will help you understand the process along the way.

In the past, choosing between health plans was tricky enough. Deductibles, premiums, out-of-pocket max costs, and prescription coverage all contribute to the quality of a health care plan, but this is a lot of information to sort through (and this does not even tell you all that your plan will cover). The introduction of the Affordable Care Act and the health insurance marketplace only complicated this matter.

Health Insurance Marketplace

Before we go too much farther, what exactly is the health insurance marketplace anyway? Healthcare.gov, the website run by the federal government, says that the Health Insurance Marketplace is, “A service that helps people shop for and enroll in health insurance. The federal government operates the Health Insurance Marketplace®, available at HealthCare.gov, for most states. Some states run their own Marketplaces.” They go on to say, “The Health Insurance Marketplace® (also known as the “Marketplace” or “exchange”) provides health plan shopping and enrollment services through websites, call centers, and in-person help.” There are also plans for small businesses, should a business need health insurance for its employees. While this may seem straightforward, it can be difficult to navigate the marketplace. How do you know what you are looking at? Are these plans the best ones you will find? What is a deductible anyway? Not to worry, we can help!

Q: “What is a Premium?”

Your health insurance premium is your most basic health insurance expense. This is the price you see listed when you go to purchase a plan. The premium is the dollar amount that you must pay for your insurance every month. Essentially, you pay this money to the health insurance provider to keep your plan active and the health insurance provider will cover the large medical expenses down the road. However, this is probably not the only cost you will have. Deductibles and copayments may be required as well.

Q: “What is a Deductible?”

Essentially, a deductible is how much money you will have to pay out of pocket before your health coverage starts to kick in. The amount that your deductible ends up being can vary from plan to plan. Many plans are called high-deductible plans and require you to pay more out of pocket, but the premiums will be lower. Other plans may have higher premiums, but the deductible can be as low as zero dollars.

Q: “What is an Out-of-Pocket Max?”

Your out-of-pocket max is exactly what it sounds like. Whatever amount your out-of-pocket max is is the maximum amount you will have to pay for health services for that year. Say your out-of-pocket max is $5,000 for 2021. If you have an expensive medical procedure, have a baby, or have a medical emergency, you will only have to pay $5,000 for whatever that total cost is. Unfortunately, your out-of-pocket max does not include your spending on premiums, out-of-network care, or spending on services your plan does not cover. So even your out-of-pocket max may not limit your health care spending.

One additional note to consider. The health insurance provider and plan that you choose will have their own limits. Many doctors and hospitals only take specific plans. These are called out-of-network providers and services will be more expensive there since those doctors’ offices or hospitals do not have cheaper, pre-negotiated rates with your provider. Take care that the health plan you choose is in-network with your primary care physician’s office or with the office where you receive specialized care. Fortunately, we can help you find a plan that meets all of your needs.

Derby Insurance Solutions

This is a lot of information to take in and to process, much less to take and make a decision with that affects your health and finances. The good news is we can help with that! As a local, family-owned business, we are devoted to protecting your family. We specialize in finding the right plan for you and your family. We can help you sort through premiums, deductibles, out-of-pocket max costs, and help you find out what a plan does and does not cover. We can also help you understand the complex Health Insurance Marketplace and what that means for your health insurance plan. Everyone will need medical care at some point in their lives, so make sure you are prepared and have a quality health insurance plan.

Here at Derby Insurance Solutions, we carry plans from many of the top health insurance providers – these include BlueCross BlueShield, United Health Care, and more! We are able to help you find a quality, affordable health insurance plan that suits the needs of you, your family, or your business. Whether you are shopping for a new plan or simply have questions about navigating the health insurance marketplace, we can help. Just give us a call at 918-451-9783 or fill out our contact form and receive a free health insurance quote!

In addition to standard health insurance, we also provide life insurance, Medicare supplements, accident insurance, retirement solutions, and Native American Benefits.


For more information about life insurance, contact one of our friendly insurance agents. We can answer your questions and help you protect what matters most to you!