How to choose the best health insurance for your family

It’s the most wonderful — and potentially confusing — time of the year: Health care insurance open enrollment season!  When considering your insurance coverage options for the upcoming year, there are some key factors to keep in mind to ensure you select the best plan for your family's needs. 

Understand your options 

Whether you are uninsured, under-insured or are renewing your existing health insurance (through your employer, the Health Insurance Marketplace or directly through an insurance company), be sure to carefully review all available plan options and levels of coverage. 

Free or low-cost benefits through Medicaid or the Children’s Health Insurance Program (CHIP) may be available to you and your family if you meet certain qualifications.  

Evaluating your health insurance needs 

There are 3 important aspects to consider when you are exploring different plan options. 

• Provider Network: Choose a plan that includes your preferred doctors, clinics and hospitals within their network to minimize your out-of-pocket costs. 

• Service Coverage: Read the fine print to understand what services are covered. Prioritize plans that cover the services you anticipate your family will need most. 

• Prescription Coverage: Verify that your plan covers necessary prescriptions. Plan documents will detail covered medications, and you can call insurers for clarification. 

Financial responsibilities 

Sometimes, it’s hard to figure out how much your health care will actually cost. Here are some key elements you can look at in each plan to help you estimate your family’s costs. 

• Monthly Premiums: Understand your monthly payment obligations and consider setting up automatic payments. 

• Copays: Estimate out-of-pocket costs for expected visits and services. 

• Deductible: Know your plan’s deductible — the amount you pay before insurance starts covering certain services. Assess whether you can afford this amount if needed. 

• Out-of-Pocket Maximum: Determine your plan’s maximum out-of-pocket expense. Once you reach this amount on covered health care expenses, your insurance will cover 100% of your costs. 

Re-enrollment considerations 

Even if you are currently enrolled in a Marketplace plan, you must update your application and confirm or change your plan by Dec. 15, 2024 for coverage starting Jan. 1, 2025. If you miss this deadline, you can enroll until Jan. 15 for coverage starting Feb. 1, 2025, but you will be uninsured in January. 

Ensure your application for coverage reflects any changes in your situation. Some of these changes will qualify you to enroll outside of the open enrollment period, too. Changes include:  

• Income increase or decrease. 
• Loss of previous health coverage. 
• Marital status changes (marriage or divorce). 
• Adding a dependent or changes in household size. 

Don’t forget to make your first premium payment by Jan. 1 to activate your coverage. Also, consider setting up automatic payments to reduce the chances of any interruptions in your coverage. 

By taking the time to evaluate these factors during open enrollment, you can make informed decisions that best suit your family’s health care needs and financial situation. To find out more about which insurance plans are in-network or out-of-network with Children’s Mercy, please visit choosechildrensmercy.org.  

If you have any questions, please email us at NarrowNetwork@cmh.edu.