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Considerations When Purchasing Health Insurance

Fortunately, the Affordable Care Act (ACA) makes it easier to get the right health coverage. All health insurance companies in California sell policies with a standard set of benefits (Essential Health Benefits) and fixed cost sharing (except for grandfathered plans). This makes it easier for consumers to shop for health coverage. It's like comparing apples-to-apples.

Some insurers also offer an alternate plan design. These may have more benefits and the cost sharing may vary.

Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.


When you buy individual/family coverage, your monthly premiums vary based on a few factors including your age, where you live, the number of persons covered, and how much of your coverage you will pay for out-of-pocket. It can be hard for consumers to pick which cost sharing is best for them. Visit our Health Insurance Costs page for more information that may help you with your choice.

Premiums are calculated differently if you are getting your coverage from your employer (group coverage). Sometimes employers will provide many plans for you to choose from with different levels of cost-sharing. Visit our Health Insurance Costs page for more information about premiums, cost sharing, and out-of-pocket expenses.

You also may have a choice between an PPO, EPO and HMO. Visit our health coverage comparison page for more information about the difference between the three.

Which doctors and other providers can I go to?

  • How large is my provider network?
  • Can I see any provider in the network?
  • Is my current doctor in the network?
  • If I need to choose a new doctor, are there doctors in my area accepting new patients?
  • Will I need a referral from my doctor to see a specialist?
  • Does the plan have hospitals and pharmacies near me?
  • Do I need pre-approval (pre-authorization) from the plan for certain services?
  • If I travel often, what care can I get away from home?

NOTE: If you want to keep or go to a specific provider and/or hospital, check with the insurer. You will need to find if they are a part of the network for the specific product you are buying. Just because a provider is a part of that insurer's network for another plan, it does not mean that he or she will be a part of the plan that you are buying. Visit our Provider Network Adequacy page for more information.

What benefits does the plan offer?

Most insurance policies now offer a standard benefits, making it easier to compare of your choices. Visit our Health Insurance Benefits page for more details.

What quality of care will I get with this coverage? How does it compare to others?

  • The California Department of Insurance can tell you how a company ranks in complaints. You can find out how long it takes to reach a live person when call your insurer and and how many complaints the company gets.
  • Every year, CDI shares a report card with quality information about PPOs. Visit our PPO Quality Report Card for more information.
  • The California Office of the Patient Advocate (OPA) also has information on health coverage and provider quality.



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