Purchasing health insurance can be an intimidating decision. And because I write about health care for a living, with open enrollment season right around the corner, colleagues increasingly ask me how I pick my own plan.
I’m a health-care reporter. Here’s how I shop for health insurance.


The six years I’ve spent writing about health insurance have helped convince me that, frustratingly, my parents are right: You really should purchase health insurance, even if you think you won’t use it. And there are things I’ve started to watch out for as I read the fine print of my plan. Here’s what I’ve learned so far; hopefully it can be of some help to you, too.
Yes, you should buy insurance — even if you’re young and healthy

If you are young and healthy and you follow this rule, you will likely end up spending more on premiums than your health plan pays out in claims. A year from now, you might rue the day you read this very Vox article that instructed you buy health insurance — wondering what on earth that writer was thinking.
I am 30, and so far, I’ve never had a year where my medical costs exceeded my premiums. It is possible I’d have more money in my bank account now if I had eschewed coverage and paid my bills out of pocket.
But the reason I’m going to buy health insurance again this year (and why I think you should too) is because I need someone else on the hook for a big, unexpected medical bill that I couldn’t afford on my own.
This is how all insurance works. You don’t buy car insurance because you expect to get in a serious accident next year, or homeowners’ insurance because you expect your house to burn down. You buy insurance so you’re covered in the case of rare but financially catastrophic events.
You don’t buy car insurance expecting an accident. And you don’t buy health insurance expecting to get sick.
Health insurance works the same way. If you’re young and healthy, you probably won’t need much health care next year. But if you do need care, it can be expensive. The average hospital stay now costs more than $10,000. That would put a serious dent in my savings — and wipe out many Americans’ savings accounts entirely. It would prevent me from doing the things I want to do, like eventually buy a house or raise children.
Most of us won’t have a hospital stay like that next year. But the reason to buy insurance is to protect ourselves against the chance that we could — because all of us do have that chance in the year ahead.
It’s all well and good for me to write this story urging every reader to buy health insurance. But it’s quite another thing to fit that plan into a very real budget, one that has to make space for dozens of other things.
Right now, people who get their health insurance at work pay an average monthly premium of $90 for individual coverage. If you don’t get health insurance at work, you can use the Obamacare marketplaces, where the lowest-cost individual plans are usually somewhere between $150 and $300 per month, depending on where you live and how old you are.
There’s also a question of what kind of value a health insurance plan delivers. Some of the Obamacare plans, for example, have a $5,000 deductible. That means people in that plan would have to cover $5,000 in medical bills before their coverage even kicks in.
This type of coverage still protects against the really big medical bills. But it also leaves subscribers with a lot of financial exposure. These are the plans that I find it hardest to weigh in on — I generally think buying health insurance is important, but would also worry about someone making major adjustments to her budget to buy relatively skimpy coverage.
So my thinking here is this: If you can make it fit with some small adjustments to your lifestyle and purchase a safety net, I think that’s a worthwhile trade-off. But if you’re looking at really big adjustments to purchase a safety net with a bunch of holes in it, I can understand the case for skipping coverage, too.
The key trade-off in health insurance: You pay more to avoid future financial risk
If you get health insurance at work, you probably have two or three plans to chose from. If you’re buying coverage on the Obamacare marketplace, you’re probably looking at more like a dozen plans. In either case, they tend to come with summaries that look like this:

These plan documents can be confusing, and I’ve written a separate piece about what the different terms mean. If there are words here that are unfamiliar, I’d suggest giving that piece a read.
There’s one general guiding principle to keep in mind as you wade through these plans: There’s typically a direct relationship between how much you pay upfront for a plan and how much it will cover.
Plans with higher premiums tend to have lower deductibles, copayments, and co-insurance. Essentially, if you pick a higher premium plan, you’re paying more money on a monthly basis so you’ll face lower costs in the future when you seek health care.
Conversely, plans with lower premiums tend to have higher deductibles, copayments, and co-insurance. With these plans, you’d be deciding to pay less upfront in premiums but taking on the risk that if you do go to the doctor or hospital, you would be responsible for a bigger portion of the bill.
There’s a decent chance your employer is now offering a plan with very low premium, or no premium at all, and a very high deductible, typically upward of $1,000. These are called, perhaps unsurprisingly, high-deductible health plans, and they’re becoming increasingly common for employers to offer.
Employers typically pair these high-deductible plans with a tax-advantaged savings account (typically a health reimbursement arrangement or health savings account) where workers can deposit part of their paycheck to cover the bills they’ll face under their deductible. Or sometimes employers will deposit a sum of money into this account at the start of the year.
These plans can be good for someone who is looking to get coverage for the cheapest possible price. But they’re also less robust coverage, and run a greater risk of leaving the subscriber with a bill he or she might not be able to pay. There’s also a growing body of research suggesting that these types of plans, because consumers face such high upfront costs, lead to subscribers skipping needed preventive services and other medical care.
With health insurance plans, as with many other things in life, you ultimately get the coverage you pay for.
Take a deep breath and remember: It’s impossible to predict your medical costs
You made it this far in the article, so now you deserve a dog dressed as a doctor. (Shutterstock)
For me, at least, this is the most stressful part of shopping for health insurance. I know that I’m going to buy coverage. I get tripped up trying to weigh how much medical I’ll need in the coming year, and how much coverage I should buy to make the most of my premiums.
There are some years when you know you’re going to have a big health-care expense — if you’re planning to have a baby, for example, or there’s a specific surgery on the horizon.
Most years, however, aren’t like that. Bones break, and emergencies happen — or maybe they don’t. Most years we get by with routine, inexpensive medical care. It’s just impossible to know which years are “most years” — and which years the really big medical bills will turn up.
There are some good proxies you can look at to estimate how much you might spend. One of the best is age; as you can see in this Kaiser Family Foundation chart, younger people tend to have lower health-care costs. Health-care costs do tend to spike for women in their early 30s, however, reflecting the costs of childbearing.

As a rule of thumb, young people can often make a smart decision and buy a less expensive plan that covers a lower amount of medical care.
But bar charts, unfortunately, don’t tell the whole story. Take my own example: In 2014, I was 28 and had a decently healthy year where I didn’t make a single doctor appointment. But 29 was a different story: as a natural-born klutz, I managed to fracture my foot, contract pink eye, and get a splinter stuck deep enough in my hand it required surgical removal.
Last year was one in which, for a while, I felt I had screwed up the calculation: If I had bought a more robust plan, I probably would have paid less out of pocket. But there was simply no way for me to know that going into 2015 — and there’s no way for me to know how many clumsy mishaps (if any) await me in 2016.
The reason you buy health insurance is for financial protection. Watching co-payments pile up this year has been annoying, especially as I think about the option I had to purchase a plan with lower ones.
It’s been annoying, but it hasn’t been catastrophic. I can still afford to go to the doctor — to get an MRI scan of that fractured foot that, after four months, still won’t heal — because I have an insurance policy in the first place.
Watch out for co-insurance
I’ve written previously on the most important health insurance jargon you should know, and you can read about that here. But in terms of actually shopping for coverage, I’d argue that understanding the concept of co-insurance is especially crucial to understanding the type of coverage you’re buying.
Most of us who have used health insurance before understand the concept of a copayment, the $10 or $25 or maybe even $50 you pay for each doctor visit. Copayments are easy to understand because they’re predictable; you’ll pay the same amount each time you see a primary care doctor, for example, regardless of which doctor you see.
But co-insurance works differently. You still pay a part of the bill, but with co-insurance it’s a set percentage rather than a set amount. So your insurance company might say, for example, that subscribers have to pay 10 percent of the cost of any imaging test like an X-ray or an MRI. Co-insurance is much less predictable because health-care prices can vary a lot. One recent study in California showed that a simple blood test can cost anywhere from $10 to $10,169. If you’re on the hook for 10 percent of that blood test bill, it means your co-insurance could be between $1 and $1,017 — a very significant difference!
Philosophically, I tend to agree with the idea of co-insurance, particularly for really standard procedures like blood tests and MRIs. They encourage patients to look for lower-price providers, and that can help lower premiums for everyone. I wouldn’t avoid a plan that uses co-insurance, but I would make a mental note of it, and keep in mind that it could require me to do more work in the future as I’d likely be responsible for finding the lower-cost doctor.
Ask questions! Lots of them. There are no dumb ones.
It’s easy to feel sheepish about bothering your HR department, colleagues, or parents about health insurance questions. But you shouldn’t! Shopping for health insurance is an inherently difficult task because you’re buying a product that you may or may not use to insure against risks that are impossible to predict.
Don’t be shy about making use of the resources you have at your disposal. If you get insurance at work, talk to your human resources department — they have put a lot of thought into negotiating your benefits package, and would almost certainly be thrilled to hear a worker ask specific questions about it.
If you’re shopping for coverage on the Obamacare markets, you can reach out to a local navigator, whose whole job is to walk people through insurance decisions. You can see who is available near you here.
Health insurance is complex, but luckily there are plenty of people willing to help — who will hopefully make your decision this year a bit less daunting.












