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5 health insurance surprises to avoid
If you buy your own health insurance, Nov. 15 has some significance to you. It's the first day of open enrollment to shop for your 2015 coverage.
This is the second shopping period under the Affordable Care Act, so all the changes the law brought about could still feel new and foreign. For many people shopping — having the option to leave your plan for a better policy — was not a consideration. Now, it is.
In Oregon, there are 13 insurers in the individual market and 10 of them are offering plans on the marketplace at HealthCare.gov. Oregon Insurance Commissioner Laura Cali says that's quite a competitive market.
This state has always had good competition, she said, but it's increased even more in the last couple of years. In some states, one company dominates the market, so consumers don't have much choice.
"Ultimately, you've got all these companies fighting to get market share," Cali said. "They seek to differentiate themselves in a number of ways. The main way is price. They're making sure they're as precise as they can when they develop their rates and it also incentivizes them to try different things with their product offerings."
But to take advantage of these offerings, consumers need to be engaged and informed. That's easier said than done. In the last open enrollment period, Moda Health Plan dominated the market on Cover Oregon -- capturing about 70 percent of enrollees. Its silver plan premium for a 40-year-old in Portland was the second cheapest.
People shopped looking at premiums then, and they're still going to largely drive consumer decisions this year, Cali said. But a low premium doesn't necessarily equate to lower total out-of-pocket costs in the course of a year's worth of health care expenses. The best way to avoid surprise medical bills is to be as informed as possible about your plan's coverage.
Here are some features other than premium prices to look at when shopping this open enrollment period.
Cost sharing
A good starting point is to think back on what kind of health care services you use and how often. While you can't predict everything, you can take into account how often you go to your doctor, if there's a specialist you see regularly and what prescriptions you take. You could also take into account any procedures you might need in the next year.
Then figure out the funds you might pay on top of premiums to access those services. Coinsurance means the plan pays a particular portion of a service, and you pay the rest. Copays are fixed amounts you pay upfront for covered care. Check your prospective insurer's website for a prescription formulary and make sure your prescriptions will be covered.
Deductible
This is the amount you pay out of pocket before your plan starts to kick in. This is where you could be hit by surprise expenses if you're not careful. A low premium and a high deductible aren't necessarily advantageous. Healthy people who don't use health services much could get away with it, but it would be wise to set aside some money that could cover your deductible in case you get sick or injured.
Doctor
If you intend to continue your relationship with your doctors, make sure to check the provider directory so you're not hit by costly out-of-pocket costs at your next appointment. Contracts can change quickly, so keep in mind that the directory might not be up to date. The safest thing is to check with both the insurance company and your doctor's office.
Beyond that, you might be interested in seeing whether the plan you're looking at offers a broad network or a narrow network. Limiting the number of providers in the plan's network is one way companies are lowering costs. That's something to consider when you are eyeing a cheap plan.
Travel
If you travel a lot for work or for leisure, check to see whether the plan has an out-of-network benefit. Some plans will cover your out-of-network services at a higher cost share on your part, but others might not cover them at all.
Agent
Are things getting mixed up in your head yet? You are not alone. Consider contacting a health insurance agent to help you get all these factors straight and find the plan that best fits you. Agents are health insurance experts who can help you for free — they make their living through commissions on plans they sell.
Source
If you buy your own health insurance, Nov. 15 has some significance to you. It's the first day of open enrollment to shop for your 2015 coverage.
This is the second shopping period under the Affordable Care Act, so all the changes the law brought about could still feel new and foreign. For many people shopping — having the option to leave your plan for a better policy — was not a consideration. Now, it is.
In Oregon, there are 13 insurers in the individual market and 10 of them are offering plans on the marketplace at HealthCare.gov. Oregon Insurance Commissioner Laura Cali says that's quite a competitive market.
This state has always had good competition, she said, but it's increased even more in the last couple of years. In some states, one company dominates the market, so consumers don't have much choice.
"Ultimately, you've got all these companies fighting to get market share," Cali said. "They seek to differentiate themselves in a number of ways. The main way is price. They're making sure they're as precise as they can when they develop their rates and it also incentivizes them to try different things with their product offerings."
But to take advantage of these offerings, consumers need to be engaged and informed. That's easier said than done. In the last open enrollment period, Moda Health Plan dominated the market on Cover Oregon -- capturing about 70 percent of enrollees. Its silver plan premium for a 40-year-old in Portland was the second cheapest.
People shopped looking at premiums then, and they're still going to largely drive consumer decisions this year, Cali said. But a low premium doesn't necessarily equate to lower total out-of-pocket costs in the course of a year's worth of health care expenses. The best way to avoid surprise medical bills is to be as informed as possible about your plan's coverage.
Here are some features other than premium prices to look at when shopping this open enrollment period.
Cost sharing
A good starting point is to think back on what kind of health care services you use and how often. While you can't predict everything, you can take into account how often you go to your doctor, if there's a specialist you see regularly and what prescriptions you take. You could also take into account any procedures you might need in the next year.
Then figure out the funds you might pay on top of premiums to access those services. Coinsurance means the plan pays a particular portion of a service, and you pay the rest. Copays are fixed amounts you pay upfront for covered care. Check your prospective insurer's website for a prescription formulary and make sure your prescriptions will be covered.
Deductible
This is the amount you pay out of pocket before your plan starts to kick in. This is where you could be hit by surprise expenses if you're not careful. A low premium and a high deductible aren't necessarily advantageous. Healthy people who don't use health services much could get away with it, but it would be wise to set aside some money that could cover your deductible in case you get sick or injured.
Doctor
If you intend to continue your relationship with your doctors, make sure to check the provider directory so you're not hit by costly out-of-pocket costs at your next appointment. Contracts can change quickly, so keep in mind that the directory might not be up to date. The safest thing is to check with both the insurance company and your doctor's office.
Beyond that, you might be interested in seeing whether the plan you're looking at offers a broad network or a narrow network. Limiting the number of providers in the plan's network is one way companies are lowering costs. That's something to consider when you are eyeing a cheap plan.
Travel
If you travel a lot for work or for leisure, check to see whether the plan has an out-of-network benefit. Some plans will cover your out-of-network services at a higher cost share on your part, but others might not cover them at all.
Agent
Are things getting mixed up in your head yet? You are not alone. Consider contacting a health insurance agent to help you get all these factors straight and find the plan that best fits you. Agents are health insurance experts who can help you for free — they make their living through commissions on plans they sell.
Source
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