How do I know which health plan to select?

With the Individual Coverage Health Reimbursement Arrangement (ICHRA), you have the flexibility to select a health plan that aligns with your specific needs. You can evaluate options based on factors such as deductibles, preferred providers, and various features tailored to your geographical location.

How to Choose the Right Health Plan for You

A guide to help you shop with confidence

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Here are some things to think about as you explore your options.

1. Start with how you actually use healthcare

Think about your last year:

• How often did you go to the doctor?

• Do you take prescriptions regularly?

• Do you see specialists or have upcoming procedures?

If you rarely go to the doctor, a plan with a lower monthly premium but higher deductible might make sense. If you see doctors often or take ongoing medication, paying more each month for a lower deductible could save you money over time.

Ask yourself:

“Would I rather pay more each month and spend less when I go to the doctor — or pay less each month and risk higher costs later?”

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2. Check your doctors and prescriptions

If you have a doctor you love or a specific medication you depend on, make sure they’re covered.

• Use the provider search to see if your doctors are in-network.

• Review the plan’s drug list (formulary) for your prescriptions.

If your doctor isn’t listed, it’s worth checking if there’s a similar provider nearby. Sometimes you can even request that your current provider be considered in-network for medical necessity.

Ask yourself:

“Is it more important to keep my current doctor, or to lower my costs with a different plan?”

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3. Decide how much flexibility you want

You’ll see terms like HMO, PPO, and EPO — they describe how the plan handles networks and referrals.

• HMO: Choose one primary doctor; referrals needed for specialists.

• PPO: More flexibility; you can see specialists without referrals, often even out of network.

• EPO: No out-of-network coverage (except emergencies), but no referrals needed.

If you like structure and don’t mind referrals, an HMO can save money.
If you travel often or prefer freedom to choose, a PPO might be better.

Ask yourself:

“Do I want flexibility to see any doctor, or am I okay working within a network to save money?”

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4. Look beyond the premium

It’s tempting to pick the cheapest monthly premium — but look at the big picture:

• Deductible: What you’ll pay before insurance starts sharing costs.

• Out-of-pocket max: The most you could spend in a year for covered care.

• Copays and coinsurance: What you’ll pay for visits and prescriptions.

You might find that paying a little more each month gives you peace of mind and predictable costs when you need care.

Ask yourself:

“If I had a major medical bill tomorrow, how much could I comfortably afford out of pocket?”

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5. Think about your lifestyle

Are you someone who travels, lives part-time in another state, or has dependents who do?
Make sure your plan covers care where you actually spend your time.
Some plans have strong local networks, while others offer broader coverage across states.

If you like convenience, look for plans that include:

• Virtual visits or telehealth

• Direct primary care

• Mental health services

• Wellness perks or fitness benefits

These can make managing your health easier and more affordable.

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6. Give yourself permission to ask questions

Health insurance is confusing — even for people who work in it every day.
If you’re not sure which plan is right for you, it’s okay to ask for help.
A licensed education specialist can walk you through your options and explain how each plan might work for your specific situation. Click on the help option in your shopping screen to schedule a virtual Microsoft Teams meeting.

Ask yourself:

“What matters most to me — cost, convenience, keeping my doctor, or flexibility?”

You don’t have to get it perfect — you just need to get it right for you. 

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Final Thoughts

The right health plan isn’t always the cheapest one — it’s the one that helps you feel covered and confident.

Take your time, think about your real-life needs, and don’t be afraid to ask for guidance.

Your health coverage is personal — and your choice should be, too.

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The benefitbay® employee experience facilitates the comparison of plans and pricing prior to making a coverage purchase.

For any further questions, feel free to contact us at support@benefitbay.com.