Important Things to Consider When Enrolling in a Health Insurance Policy

(aka: please don’t pick a plan the way you pick a Netflix show)

Let’s get one thing out of the way: Most people choose health insurance based on exactly two things—the monthly premium and vibes.

I get it. The system is confusing, the language is awful, and no one wants to spend their free time decoding insurance jargon. But unfortunately, health insurance is one of those areas where a quick decision can turn into a very expensive learning experience.

So before you enroll (or re-enroll), here are the things you actually need to think about—whether anyone explained them to you or not.

1. The Monthly Premium Is Not the Whole Story

If the plan looks suspiciously cheap, it’s because the bill shows up later.

Lower premiums usually come with:

• Higher deductibles

• Higher out-of-pocket costs

• Limited coverage when you actually need care

A $0 or low-premium plan can still cost you thousands if you use it. Insurance doesn’t care that you were trying to be financially responsible.

2. Deductibles, Copays, and Coinsurance (Yes, They’re Different)

This is where people mentally check out—and where problems begin.

• Deductible: What you pay before the plan really kicks in

• Copay: A flat fee for certain services

• Coinsurance: A percentage you pay after meeting your deductible

Some plans make you pay everything until the deductible is met. Others don’t. If you don’t know which one you’re enrolling in, you’re gambling.

3. Networks Matter More Than You Think

“Accepts my insurance” is not the same as “in-network.”

Doctors, hospitals, urgent care centers, and even labs can all be out-of-network—and that’s how surprise bills are born.

Always check:

• Your primary care provider

• Any specialists you see

• The hospital you’d realistically go to in an emergency

If your preferred providers aren’t in-network, the plan may not be the deal you think it is.

4. Prescription Coverage Can Make or Break a Plan

Not all plans cover all medications. Shocking, I know.

Each plan has a formulary (a drug list), and medications can fall into different tiers with wildly different costs. Some require prior authorization. Some aren’t covered at all.

If you take prescriptions regularly, this deserves more than a quick glance.

5. The Out-of-Pocket Maximum Is the Safety Net

This is the most important number on your policy—and one of the most misunderstood.

Your out-of-pocket maximum is the most you’ll pay in a year for covered services. If something big happens, this number suddenly matters a lot.

Lower isn’t always better (because premiums go up), but ignoring it completely is a mistake.

6. Enrollment Is Not the Finish Line

This is the part almost no one explains.

After you enroll, you usually must:

• Make your binder (first) payment

• Confirm the payment was received and applied correctly

• Wait for coverage to activate

• Receive your ID cards

No payment = no active coverage. Enrollment alone does not protect you.

Yes, this causes a lot of avoidable problems. No, the system does not forgive confusion.

Final Thought

Health insurance isn’t intuitive—and it’s definitely not designed to be simple. The “best” plan depends on how you actually use healthcare, not just what looks cheapest on paper.

If you’re unsure, overwhelmed, or staring at plan details wondering if you’re missing something… you probably are. And that’s not a personal failure—it’s the system doing what it does best.

Ask questions. Double-check details. And don’t assume insurance will cut you any slack if things go sideways. They won’t.