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Life Kit: Picking the right health insurance for you


It's autumn, and autumn is all about leaves changing color, pumpkins and open enrollment. Wait, don't go. Health insurance is important, and fall is when everyone has a window to switch up their plan, try to get a better deal or better coverage. So how do you pick the right plan? NPR health policy correspondent Selena Simmons-Duffin has some helpful tips.

SELENA SIMMONS-DUFFIN, BYLINE: How hard it is to pick a plan is going to vary a lot. Maybe you're picking from one or two options through work. Ask your coworkers what they like. Call it a day. On the other hand, if you're shopping in the Affordable Care Act marketplaces like healthcare.gov...

AARON DELAO: If you're in Texas, in my - in our market area that we help serve clients in, we had 76 plans to review with clients.

SIMMONS-DUFFIN: Yikes. That is a lot of plans. That is Aaron DeLaO, by the way. He is the director of health initiatives with an organization called Foundation Communities in Austin. And he says even with dozens of options, you can narrow it down with some basics. So here's a tip to help get you started. Use what's predictable about your health to guide you. Aaron DeLaO says start with this question.

DELAO: Do you want insurance for that catastrophic event that might happen? Or do you know you have a health issue now that you're going to need ongoing care for?

SIMMONS-DUFFIN: If you're pretty healthy but you want that protection if, heaven forbid, you did get a bad injury or a serious diagnosis, that might steer you towards more basic plans. If you have ongoing health needs you know you'll need coverage for, those can be really useful for narrowing down your options. Aaron says, think about the prescription drugs you know you'll be taking, the doctors you want to be able to see and the hospital you'd like to be able to go to if you need it.

DELAO: If there's a plan that doesn't have your provider or your medications in network, those can be eliminated - right? - because if you really want to stick with your provider and you know you're going to need these prescriptions ongoing, let's find a plan that's going to cover those.

SIMMONS-DUFFIN: Sometimes you can input this information while you search online to filter out the plans that won't work for you. When in doubt, call the insurance company and ask, is my provider in network for this plan? Is my medicine on the plan's formulary? That's the list of medications an insurance plan will cover. One thing to note, says Sabrina Corlette of the Georgetown Center on Health Insurance Reforms, is that some plans have more flexibility when it comes to covering things out of network than others.

SABRINA CORLETTE: You may have a choice between what's called an HMO or a PPO.

SIMMONS-DUFFIN: HMO stands for health maintenance organization. PPO is preferred provider organization.

CORLETTE: And without getting too wonky, an HMO is typically a plan that doesn't let you see out-of-network providers. You can, but you're paying 100%. But a PPO will give you a lot broader choice that providers. It might be a little bit more expensive to see an out-of-network provider, but they'll still cover some of that cost.

SIMMONS-DUFFIN: If you are completely overwhelmed by all of this, that is truly understandable. It is complicated. But you can get help. Your job might have helpers to guide you through your benefits at work. And if you're buying insurance on your own through healthcare.gov, click on Local Help to find assister like Aaron DeLaO. They're free, impartial and can sign you up in something like an hour and a half.

OK. Health insurance is important, but it's also confusing. It asks a lot of us. Hang in there. Get help if you need it, and make sure you get covered. Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.