What to Consider When Choosing Health Insurance

Can I get insurance through my employer?

Review the insurance plans available through your employer and whether they cover your family members.

Do I qualify for any government-funded health insurance? Does anyone in my family, including my children, qualify?

In the U.S., families and individuals may be eligible for one of the 3 main government health insurance programs.: Medicaid, Medicare and the Children’s Health Insurance Program (CHIP). Eligibility depends on income, age, health condition(s) and more.

Are our healthcare providers in network?

Think about the providers your family visits regularly (including your primary provider and pediatrician), as well as urgent care locations and emergency rooms. Make sure these are in-network when reviewing plans.

Is Children’s Healthcare of Atlanta in network?

Children’s Healthcare of Atlanta is the only nationally-ranked, freestanding pediatric hospital system in Georgia. While we hope your child never needs to step inside the halls of any our three hospitals, eight urgent care centers or numerous specialty clinics, we are here if you need us. Find a Children's location, and learn more about which plans Children’s is contracted with.

Does anyone in my family have serious health problems or need special treatment?

Think about any specific health needs you and your family may have that may require access to specialty providers, including therapists and other providers.

If any of our providers are not in network, am I willing to find new providers who are?

Think about how strongly you feel about staying with your current healthcare providers and the potential impacts of having to find new providers. Changing providers may be especially challenging for families with more complex medical needs and history.

Do we need coverage outside of the United States?

If you frequently travel outside the U.S., you may want to think about getting extra coverage in case you ever need specialty services when you are out of the country.

Does anyone in my family take specific medications?

Check if any medications that you and your dependents take are included in the formulary (the list of prescription drugs your payer will cover). It is important to make sure the medications you or your dependents are prescribed are included in the payer’s formulary.

How and where do I obtain our medications?

Check your insurance options to see if there are limits on how you obtain your medication (e.g., in the mail, in store, etc.).

What will my monthly cost be?

Calculate the monthly cost, or premium, you will be paying to cover you and your family.

What other costs will I be paying?

Look at how costs are set up for deductibles, coinsurance, copay, and the annual out-of-pocket maximum for in-network and out-of-network services. And are there different out-of-pocket costs for your pharmacy benefits? Based on your family’s medical history, try to estimate how these costs would all apply to your current healthcare needs.

How often, on average, do my family and I need medical care?

There are 3 common types of healthcare plans with different cost set ups.

• Families or individuals who seek medical care more often may benefit from a plan with a higher premium (set monthly cost) but lower copays and coinsurance. This is typically found with a Preferred Provider Organization (PPO) plan.
• Families or individuals who typically only seek preventive healthcare may benefit from a Health Maintenance Organization (HMO) plan. These plans typically have lower premiums and out-of-pocket costs. A Point-of-Service (POS) plan may also be a better option to get a larger network than with an HMO.