What deductibles, copays, and coinsurance actually mean, how to check if therapy is really covered, and what to ask before you pick a plan.
See a licensed doctor over video for everyday stuff — colds, rashes, prescriptions — often for less than an ER copay.
Therapy and counseling sessions, often including virtual options, covered under most plans — not an afterthought add-on.
Generic and brand-name medications at negotiated rates — many plans offer a tool to check your real cost before you pick up a prescription.
Coverage for the stuff that can't wait for an appointment — sprains, infections, the 2am "is this serious" moments.
Annual checkups, vaccines, and screenings — typically covered at $0 because catching things early is cheaper for everyone.
Bundle in dental cleanings and an eye exam + glasses allowance — built for people who keep "meaning to" book these.
A lower premium usually means a higher deductible. If you rarely need care, that trade-off may make sense — if you see doctors often, it might not.
A plan can look great on paper and still be a poor fit if your current doctor or therapist isn't covered under it.
"Covered" can mean very different copays and network sizes between plans — don't assume it's equivalent across providers.
This is the real ceiling on what you'd pay in a bad year — arguably more important than the deductible alone.
Outside open enrollment, your options narrow significantly unless you have a qualifying life event — timing your comparison matters.
Ask for the exact dollar amount, not just confirmation that "mental health is covered."
Confirm whether telehealth visits, prescriptions, and specialist visits all count toward the same deductible.
Ask directly what that means for referrals and out-of-network care — the differences affect your day-to-day access to care.
Ask the provider to confirm this specifically rather than assuming a "large network" includes the people you already see.
This is the most you'd pay in a worst-case year — make sure you know this number, not just the deductible.
Drug formularies vary by plan — confirm your specific medications rather than assuming generic coverage applies.
What "mental health coverage" really means and how to check yours.
Read it →The three terms that confuse everyone, explained with actual examples.
Read it →The age cutoff, the exceptions, and when it's time to get your own plan.
Read it →The dates that matter and what your options are if you miss the window.
Read it →Marketplace plans, subsidies, and what to look for when no one's covering half your premium.
Read it →