4 Things To Keep In Mind When Choosing A Health Insurance Plan

doctor and patient

Since the implementation of the Affordable Care Act, (commonly known as Obamacare) access to affordable health insurance for most individuals has improved. However, navigating Healthcare.gov can be a complex task, as it presents numerous bewildering options. Here are some key points to consider when selecting a health insurance plan, whether through the Marketplace or independently. It is advisable to begin by exploring the Marketplace, as private health insurance tends to be considerably more costly. If your employer provides insurance, this information may not be applicable to you. However, if you have multiple plan options through your employer, it is still valuable to be aware of the following details.

Premium cost

There are 5 categories of Marketplace insurance plans (in order from lowest to highest premiums): Catastrophic, Bronze, Silver, Gold, and Platinum. Plans in these categories differ based on how you and the plan share the costs of your care. Catastrophic plans offer the lowest premiums with the highest deductibles (i.e. what the insurance expects you to pay upfront before your coverage will kick in). Platinum plans have the highest premiums with the least out-of-pocket costs, and the others fall somewhere in the spectrum. How much you can comfortably afford to spend on health insurance each month should be your starting point for determining what health plan to pick.

Medical needs

While it’s true that not all medical expenses can be predicted, individuals with chronic conditions typically have a reasonable understanding of their basic healthcare needs for the year, such as the number of doctor or specialist visits and required prescriptions. By estimating these needs in advance, you can choose a health plan that aligns with your requirements and helps you save money. Consider the balance between your annual premium expenses and your frequency of doctor visits. If you have frequent visits, a plan with comprehensive coverage will be more beneficial. However, if you are in good health and relatively young, it may be worth taking a financial risk by opting for a higher deductible and lower premium plan. In the long run, a higher premium plan could still be more cost-effective if you have substantial medical needs.

Out-of-pocket costs

Every plan has slightly different features — deductible amount, copayment amount for PCP (primary care physician) and specialist, network coverage, services covered, and the list goes on and on. You’ll want to go over each possible plan with a fine-tooth comb and an eagle eye to make sure that you are getting the best deal for your money and the best fit for your medical needs. Of primary importance, though, is the amount you’ll be required to pay out-of-pocket. The deductible, the copayment, and the coinsurance are the patient’s responsibility. Deductibles range from $0 to several thousand dollars depending on the plan. Copays are not included with all plans, but they generally start at $20 for a PCP visit and $40 for a specialist. Some plans also require coinsurance, meaning that the insurance will expect you cover a portion of the service yourself (often this is 20% but can be as high as 50%). Depending on the amount of medical care you need in a year, you will need to weigh the financial responsibility you’d be willing to assume.

Network reach

If you go to a doctor you really like, you’ll need to consult with them to see which insurance plans they are in-network with before choosing your own. Going to a doctor/lab/specialist out-of-network can be significantly more expensive as most insurance plans pay less. The lower tier Marketplace plans often are much stricter about their networks and their out-of-network payments. If you’ve recently moved, you’ll still want a larger number of doctors to choose from; make sure you pay special attention to the network (or lack thereof) in the insurance plan you’re investigating.

Please note: enrollment is currently closed at Healthcare.gov but reopens again November 1st. If you have a special situation (such as losing a job or losing insurance through a life event), you might still qualify for 2015 insurance; click on the above link for more information and to apply.

The Alliance Direct Benefits has been committed to the idea of affordable healthcare for many years. Members have numerous health and wellness benefits; such as mail order pharmacy discounts, a 24/7 on-call doctor information hotline, financial assistance for maintenance medications, discounts on lab tests and diagnostics, and a plethora of emergency-related benefits and assistance. Should the Marketplace not cover your insurance needs or if you not qualify for a subsidy, the Alliance offers members access to the American Health Insurance eXchange where a licensed health care professional can help guide you through the process of selecting a health plan. For more information, and to become an Alliance member, visit the Alliance Direct Benefits website today or call us at 1-800-733-2242 (M-F, 7am-5:30pm Central Time).