Updated by Progyny Editorial Team. Reviewed by Dr. Jennifer Trachtenberg — May 2025.
As your family grows, your health insurance plan will likely change to accommodate new needs. Choosing a plan when you are single looks very different than selecting a health plan for a family with children.
When picking the best health insurance plan for your family, think about:
- Your health and your family’s health
- If your providers are in-network
- How many doctors and hospitals are in-network
- If you need a referral to see a specialist
- Look at how the plan fits your budget
Understanding your costs: monthly premiums, deductibles, co-pays, and coinsurance
Health insurance helps cover your medical expenses, but you still share some of the costs. That’s where monthly premiums, deductibles, co-pays, and coinsurance come in. Here’s how each one works, and how they all fit together.
Monthly premium
The monthly health insurance premium is the amount you pay each month to maintain your health insurance coverage. This might be paid by your employer, but more commonly you and your employer share the cost.
Deductible
Your deductible is the amount you pay for covered care each year before your plan starts to share the costs. Once you’ve met your deductible, your plan helps pay for most covered services. You may still have co-pays or coinsurance after that, depending on the service.
Co-pay
A co-pay is a fixed dollar amount you pay for certain services, such as a provider visit or prescription. You usually pay it at the time of service. Some co-pays apply before you meet your deductible and can count toward your out-of-pocket maximum.
Coinsurance
Coinsurance is your share of the cost for a service, shown as a percentage. For example, after meeting your deductible, you might pay 20% of the bill while your plan pays 80%. Coinsurance continues until you reach your out-of-pocket maximum.
Out-of-pocket maximum
The out-of-pocket maximum is the most you’ll pay in a plan year for covered care. It includes what you spend on your deductible, co-pays, and coinsurance. Once you reach this limit, your health plan will pay 100% of covered costs for the rest of the year.
Choosing a health plan for your family
Before you pick a health plan for your family, check if your family’s current providers and preferred clinics are in-network. Also, think about the year ahead. From routine checkups to sports physicals to surprise colds, make sure you’re prepared with the right balance of cost and coverage.
Here’s a quick look at the five most common types of health plans, with tips to help you find the best fit for your household.
Health maintenance organization (HMO)
Lower premiums, in-network only
HMOs typically cost less each month but only cover care within the plan’s network. You’ll need to choose a primary care provider (PCP) for each family member and get referrals to see specialists that are in-network.
An HMO might be a good fit for your family if:
- Your family doctors are already in-network.
- You don’t mind coordinating care through a PCP.
- You don’t expect to need frequent specialist visits.
- You want lower monthly premiums and predictable co-pays.
Why families choose it:
It’s budget-friendly and easy to manage. Co-pays are straightforward, and there’s usually no surprise billing when you stay in your plan network. That’s great for families who want simplicity and savings.
Preferred provider organization (PPO)
More flexibility, higher premiums
PPOs let you see any provider, in-network or out-of-network, and you don’t need referrals. It’s more flexible, which can be helpful for families with complex or ongoing care needs.
A PPO might be a good fit for your family if:
- You want the freedom to choose doctors without referrals.
- You have kids who see specialists or need regular follow-up care.
- You’d rather pay more each month for easier access to care.
- Your family’s healthcare needs vary, and you want options.
Why families choose it:
It’s ideal if your family needs a range of services or if your preferred providers aren’t in-network. The flexibility can be worth the higher premium.
High-deductible health plan (HDHP)
Lower premiums, higher upfront costs
HDHPs offer lower monthly premiums but come with higher deductibles. They’re often paired with a health savings account (HSA), which lets you save money tax-free for medical expenses.
An HDHP might be a good fit for your family if:
- Your family is generally healthy and doesn’t need much medical care.
- You’d rather pay less each month and save future costs in an HSA.
- You’re comfortable budgeting for a higher deductible if someone needs care.
- You want to take advantage of tax-free HSA contributions.
Why families choose it:
This can be a smart choice if you don’t expect many health expenses and want to save on premiums. Just make sure you’re prepared for a larger bill if your child breaks an arm or needs unexpected care.
Point of service (POS) plan
Balance of structure and flexibility
POS plans combine features of HMOs and PPOs. With this option, you’ll choose a PCP for each family member and need referrals from specialists. However, you can see an out-of-network provider if you’re willing to pay more and handle a bit of paperwork.
A POS might be a good fit for your family if:
- You value coordinated care through a PCP.
- You want the option to go out-of-network occasionally.
- You don’t mind submitting claims if you use out-of-network providers.
Why families choose it:
POS plans offer a middle ground: lower costs when you stay in-network. They do have flexibility if you need to see an out-of-network specialist.
Exclusive provider organization (EPO)
In-network care, no referrals needed
EPOs require you to use doctors and hospitals in-network, but you don’t need a referral to see a specialist.
An EPO might be a good fit for your family if:
- You’re OK with a smaller network of doctors and facilities.
- You want to see specialists without a referral.
- You’d rather not choose a primary care provider.
Why families choose it:
As long as your preferred doctors are in-network, it’s a solid option if your family’s care needs are fairly simple. You can skip the extra steps of referrals, too.
What health insurance usually covers for families
Most health plans cover a set of preventive services for kids at no extra cost — and that’s great news for parents. These services include routine checkups and exams that help you stay on top of your family members’ health and development.
It’s important to know that these preventive visits are different from appointments for an illness or injury. So, it’s a good idea to be clear about what your appointment is for when you schedule it. Be sure to ask questions during the visit. These checkups are a great time to talk with your child’s pediatrician and raise any concerns you may have. Come prepared with a list of questions you want to discuss to help you get everything answered
Their provider will also do a basic eye check during the first year. What does that check typically involve?
- It measures how clearly your child can see.
- It tests how well their eyes can track moving objects and stay focused.
- It looks to see if their eyes are aligned and working together.
Summary
Choosing the right health plan for your family comes down to what matters most to you. It could be saving on monthly costs, having the freedom to see any doctor, or keeping care simple and in-network. There’s no one-size-fits-all answer, so take time to consider your family’s health needs, budget, and preferences.
And once you’ve picked a plan, be sure to make the most of it — especially the preventive care services that help keep your whole family healthy all year long.
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