Chapter 5 · 9 min read

Choosing the Right Plan

Here's the framework we walk every first-time buyer through. Five steps, no jargon.

Step 1: Estimate your care for the year

Be honest. Count: annual physical, any therapy or counseling, ongoing prescriptions, planned procedures (dental cleanings don't count — those are separate), specialist visits you actually go to.

Step 2: List your "must keep" providers

Any doctor, therapist, or specialist you're not willing to lose. Their network status will narrow your options.

Step 3: Check your prescriptions against the formulary

Take any regular medication? Look it up on each plan's drug list before enrolling. A "great" plan that doesn't cover your meds isn't great.

Step 4: Run the worst-case math

Add 12 × monthly premium + out-of-pocket maximum. That's the most you could pay in a truly bad year. Could you cover that? If not, consider a higher-premium / lower-deductible plan.

Example

Plan A: $200/mo, $7,500 max → worst case $9,900.
Plan B: $340/mo, $4,000 max → worst case $8,080.
Plan B is actually cheaper in the worst case, even though the monthly premium is higher.

Step 5: Sanity-check with a human

This stuff is high-stakes and easy to get wrong. Talk to a licensed guide before you finalize. It's free, no commission on either side, and they can spot the gotchas in 10 minutes.