It had a low premium of just $174 a month, but that was partly because it had a high deductible and partly because certain expensive treatments were specifically excluded. For example, the plan does not pay for maternity care, which Wheat says she doesn't need.
But other restrictions may not be as simple or clear. Some plans limit payouts to doctors who aren't in their network, applying not only higher co-insurance amounts but dollar limits on how much care could be covered. You could be on the hook for the rest. Other plans may deny pharmaceutical coverage if you get anything besides generic drugs.
You need to get past the marketing brochures and look at the statement of benefits to figure out what's not covered, Miles said. That's because if you get uncovered services, the amount you spend for them does not count for your deductibles or out-of-pocket limits. Naturally, that could have a dramatic effect on your health costs.
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Getting the biggest bang for your buck
Before you start to compare policies, pull out your past medical records to see how many prescriptions you fill each year and how many times you go to the doctor or hospital. Create a grid to compare policies side by side so you can clearly see what each will cost you if you use medical care as you have in the past.
Also consider what would happen if you had a really bad health year. A study by the Kaiser Family Foundation noted that it's common for people to have limited healthcare use for many years, but then have a year or two of extraordinary costs.
How much risk would you shoulder if you had one of those terrible years? To figure that out, look at both your family deductibles and your annual out-of-pocket limits.
Finally, consider what you can afford. Would your finances be devastated if you hit the topmost limits of what you'd be forced to pay for two or three years? If so, you might want to choose a policy with lower annual out-of-pocket maximums.
Before you decide that what you need is a policy that covers everything, realize that the premiums for Cadillac coverage can sometimes be more than you would pay for your care each year in cash.
The trick is insuring only what you can't afford to risk.
"Use the premiums as a guidepost," Miles said. "If you look at the low out-of-pocket plans and it's $1,000 a month, but the high-deductible plan is $400 a month for your family, that leaves you $600 a month to pay medical expenses.
