The White House hopes 9.1 million people will purchase health insurance coverage through the state and federal government affordable care markets upon open enrollment, but the Congressional Budget Office estimates that nearly 13 million will. Millions more will consider plans offered by their employers during their own open enrollment periods.
There are countless plan options, numerous insurers, and health insurance vocabulary that may seem like a foreign language. But by learning the most important factors to consider when comparing plans, you can approach the situation with some confidence and be more likely to end up with a plan that is perfect for your healthcare needs.
1. How much is your monthly premium?
Your health insurance premium is the price you pay, usually on a monthly basis, for your coverage. Figure out how much you can afford to spend on your policy so you can narrow down your choices. This consideration is obvious, but it is often the first and only thing people look at when choosing a plan. Unfortunately, a lower premium doesn’t always mean lower overall medical costs, and that’s probably just one of the many expenses you’ll have.
2. What are your medical needs for the coming year?
It can seem difficult to estimate how often you will need to see the doctor or whether or not you will need surgeries and hospitalizations. That’s right, there is a certain amount of medical care that is unpredictable. But calculating how often you see a doctor, on average, or whether or not a chronic condition will send you to a specialist or hospital will help you determine which plan features will cover you the best.
3. How much do you want to pay out of pocket for the services?
Cost sharing is a term applied to the various items that you and your insurer will share the cost of. This includes deductibles, co-payments, coinsurance and maximum reimbursable amounts. These features of the plan are a frequent point of confusion. So what are they?
A deductible is the dollar amount you must spend before your insurer contributes. Sometimes insurance plans allow a number of regular doctor visits or prescriptions outside of the deductible; for those, you will pay a co-payment instead. A co-payment is a fee you pay for certain services. For a visit to the doctor, it’s usually between $ 15 and $ 30.
Coinsurance, on the other hand, is a percentage of your bills that you will have to pay – normally after you reach your deductible and before you reach your maximum. If your coinsurance is 20 percent, the health insurance company will cover the remaining 80 percent of your medical bills.
The maximum payout is a cap on the amount of money you will need to spend during the coverage year. Once you reach this cap, your insurance company will pay for 100 percent of the covered network services.
4. Do you take prescriptions regularly?
Under the Affordable Care Act, all health insurance plans must have prescription drug coverage. It is one of the 10 essential health benefits required by health law. But the scope of this coverage varies considerably.
If you take prescriptions regularly, check to see if the plans you are considering have your medications listed on their formulary, which includes all medications covered by an insurance company. They may only cover one drug from each category, so if you are dependent on a specific drug product, it is important that they list it.
5. Is your doctor part of the network?
All insurance companies have a network of doctors and medical facilities with which they work. If you visit someone who is not on the network, they may not cover the full cost and reject your request altogether. Make sure your regular medical providers are part of the network you choose, unless you want to find a new doctor.
In addition, it is important that your insurance plan covers a good mix of facilities and providers in your geographic area. Having to drive for an hour to get medical attention is not only inconvenient, it can be dangerous or even impossible in an emergency.
Choosing a health insurance plan from the range of options can be difficult. But you are not alone. As millions of people search for new coverage, helpful resources are often just a click away.