Under the Affordable Care Act, all American adults were required to have health insurance, or face paying a fine. Congress eliminated that component of the law last year, but it’s still a good idea to make sure you and your family are covered. Whether you’re new to picking a plan, or new to having a family (well done, and we promise you’ll get to sleep again eventually), these are the things you should consider.
Health insurance through your employer
Generally speaking, this is where to start—your employer has greater leverage when negotiating with an insurance company than you’ll have on the open market, so you’re most likely to get better coverage and/or lower premiums through your employer than you would otherwise. (This isn’t always the case, but it’s still the smartest place to begin.) Even high-deductible plans might be made more affordable if your employer offers to contribute money to a health savings account (HSA). And while it’s a small thing, it’s worth pointing out that if you’re the kind of person who gets overwhelmed when making this kind of decision, going through your employer also helps narrow down the types of plans you’ll have to consider. Just note: You’ll want to pay extra attention to when you can enroll, and when you’ll have the opportunity to adjust your plans, so you don’t miss out on coverage
If your employer doesn’t offer health insurance, or if you’re a contractor, or if you don’t like your employer’s plans, or if for any other reason employer-provided health insurance isn’t an option, you’ll need to see what’s available on the open market. Start by going to healthcare.gov and entering your zip code to see what’s out there on the federal marketplace, or in your state’s Affordable Care Act marketplace (where applicable). Just be aware that if you are declining your employer’s coverage options, you are most likely ineligible for any subsidies on your plan.
Determine your expected health care needs
When looking at the available plans, ask yourself: What’s covered? What isn’t (if anything)?
What about dental or eye exams? FYI: The ADA recommends that children visit the dentist within six months of getting their first tooth, or at age 1, whichever comes first. And, the AOA recommends having your kids’ first eye exam between ages 3 and 5.
What about any prescriptions you and your family might have? Only you know your family’s health requirements—though you could also consider talking with your family doctor.
Speak with your family doctor
Another reason you should consult with your family doctor is to find out what types of insurance he or she accepts, and what networks he or she is in. Depending on what kind of care you regularly need, and how you feel about your doctor, this might be a more critical factor for some families than others. And as many parents will tell you, kids have a way of bonding with certain doctors, and that bond is not easy to replace.
Frame up potential costs with your budget
Simply put, you’ll want to measure your possible premiums against your possible deductibles and co-pays. While it’s practically futile to predict your family’s health—that’s why you need insurance—you can make a reasonable estimate based on your past and recent experiences. In short, you should aim for the lowest possible deductibles, without paying more than you can afford on your plan. (Oftentimes, more expensive plans come with lower deductibles and vice versa.)
Finding that elusive balance will depend on your overall health, what you can afford, and what plans are available. One useful exercise is calculating the minimum guaranteed expense of each plan, and then weighing that against the maximum possible expense (with or without a big-ticket event like a hospital stay). The results of this exercise may surprise you, and it should only take a few minutes to do it. It’s worth your while and your budget will thank you.
Consider a dual health insurance plan
If you and your spouse both have access to insurance through your employers, you can get what’s known as a dual health insurance plan. This is when both spouses get coverage from both employers. Why would you do this? Basically, to cover your bases, and to get as much insurance coverage as possible. Typically, the oldest ongoing plan becomes the “primary” plan, and the younger ongoing plan becomes the “secondary” plan. If you incur a medical expense that’s considered covered under both plans, and the primary plan will cover 50% of the expense, and the secondary plan will cover 20% of the remainder. Another advantage is that if one of you becomes unemployed, you will still have health coverage through your spouse.
Again, the above rules are about balancing what you can afford with what you need still apply.
Choosing health insurance can seem daunting — especially when you have young kids–, but the important thing to remember is that once you break it down into a few key questions, it’s actually a lot easier to pick a plan than you think. Whatever you do, don’t put it off or skip coverage altogether, or you’ll possibly wind up paying more in bills than you would’ve on coverage.
Louis Wilson is a freelance writer whose work has appeared in a wide array of publications, both online and in print. He often writes about travel, sports, popular culture, men’s fashion and grooming, and more. He lives in Austin, Texas, where he has developed an unbridled passion for breakfast tacos, with his wife and two children. Opinions expressed by the author are their own, and do not necessarily represent the views of Haven Life.