Health Insurance 101

Key Factors to Consider

When choosing health insurance, start by considering your personal risk factors and financial constraints at the bottom layer. As you move to the top layers, these are the health insurance features available for selection, understanding that you'll need to make trade-offs.

Brand  
Quality Rating
Access to Care  
Network Size
Referral Requirement
Prior Authorization Requirement
Cost Sharing  
Metal Level (Bronze, Silver, Gold, Platinum)
Plan Design (deductible, copay etc.)
Drug Formulary
Lifestyle Risk  
Health Status
Social Determinants
Hobbies
Budget  
Govt Subsidies
Monthly Budget
Emergency Fund
Risk Tolerance  
Personal Belief
Family Safety Net
Financial Preparedness

Expected vs Unexpected Risk

There are two goals to consider when choosing the best plan.

To provide the best financial outcome based on current healthcare needs.
To protect you financially when unexpected healthcare needs arise.

Expected risk refers to events or situations that are predictable, routine, or likely to occur over time. Examples:

  • Routine doctor visits for check-ups or preventive care.
  • Medications prescribed for chronic conditions such as hypertension (high blood pressure), diabetes, asthma, and high cholesterol.
  • Maternity and prenatal care (although it can be unexpected in some cases).

Unexpected risk refers to events or situations that are unforeseen, sudden, or have a low probability of occurrence. Examples:

  • Accidents resulting in emergency room visits or hospitalization.
  • Diagnosis of a serious illness requiring extensive medical treatment.
  • Unexpected complications arising from medical treatments or procedures.

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