Health Insurance

Health plans are hard to compare because the premium — the number on the front — is the one that tells you least. Four numbers, read together, tell you what a plan will really cost in a year.

The four numbers

1. Premium — what you pay every month whether you use the plan or not.
2. Deductible — what you pay yourself before the plan starts contributing.
3. Copay and coinsurance — your share of each visit or procedure after the deductible.
4. Out-of-pocket maximum — the most you can spend in a plan year. This is the number that defines your worst case.

A low premium with a high deductible is a bet that you will not need much care. A higher premium with a low out-of-pocket maximum is a way of buying certainty.

Networks

A plan pays most when you use doctors and hospitals inside its network. Before choosing, check three things by name:

• Your existing doctors
• The hospital you would actually be taken to
• Any specialist you see regularly

Out-of-network care is usually covered at a much lower rate, and sometimes not at all except in an emergency.

Prescriptions

Drug cover works on a formulary — a tiered list. The same prescription can sit in tier one on one plan and tier four on another, which changes its annual cost considerably. Check each regular medication against the formulary rather than assuming.

If one thing on this page is worth doing, it is reading the summary of benefits and coverage. It is a standard four-page document, every plan has one, and it answers in plain language what a hundred pages of policy wording does not.

Preventive care

Most plans cover a defined set of preventive services — screenings, immunisations, an annual check — without applying the deductible. It is the part of a plan people pay for and never use.