How to Pick the Right Health Insurance Plan

Some people who chose policies with low premiums had a hard time budgeting for their high deductibles and ended up with big out-of-pocket expenses for prescription drugs and health care throughout the year. Look through your records to see how much you spent for health care and drugs; many insurers have tools that itemize your expenses. If your employer offers several policies, see whether you could save money with a high-deductible plan. You can then use that money tax-free for medical expenses in any year. The majority of people in the U.S. get health insurance through an employer, whether it’s their own or their partner’s. For those people, getting health insurance means signing up for a plan when you join a company.

Do you like your current doctor?

An annual survey estimates the increase in costs and cost-sharing next year. There are trade-offs between the two options, and you’ll have to decide if it’s worth it to you to pay more for the flexibility of a PPO. „Brokers do get commissions, but in my experience, the good brokers want repeat customers and that means happy customers,” she says. To find a good broker, she advises, „go through either Healthcare.gov or your local state department of insurance to find somebody that’s licensed and in good standing.” Profit and prosper with the best of expert advice – straight to your e-mail.

Buyer Beware: New Cheaper Insurance Policies May Have Big Coverage Gaps

As suggested earlier, you still might want to check out the options that are available to you through the federal or state health insurance marketplaces (whichever applies to you) even if you’re perfectly happy with the plan you have now. That said, it’s possible you may qualify for a “special enrollment period” that will allow you to buy a marketplace plan even though the year’s open enrollment period is over. To qualify, though, you’ll have to have gotten married, had a baby, lost your health coverage for one reason or another or gone through one of the other life events mentioned in our “Understanding the Affordable Care Act” article. The bad news is that the “open enrollment period”—the period of time when people can enroll in a health plan through the above-mentioned marketplaces–for 2015 just closed for most people. (For this year, the period lasted from November 15, 2014, to February 15, 2015.) That means you’ll have to wait until 2016’s open enrollment period (which is set to begin in mid-October) before you can enroll.

Higher premiums, more coverage

• If you already have a policy and don’t do anything, you’ll generally be reenrolled in your current policy.
• If you need specialized care or medications, talk to the insurer before you commit, and make sure you understand the insurer’s appeals process.
• Search each plan’s provider network for primary care providers, hospital services and specialists in your area so you can get a sense of your options.
• Your choices will be limited to the set of options that your employer offers.
• The National Business Group on Health’s survey of large employers usually provides the first glimpse of changes employers will be making to their health insurance plans for the coming year.
• Compare the levels of coverage for the health insurance plans that your job offers.

The level of coverage that’s the best value depends on how much medical care you need. „In this country it is a truly wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University. In some cases, calling the plans’ customer service line may be the best way to get your questions answered.

Choose the type of health insurance plan

If you’re relatively healthy, the best deal is a cheap health insurance plan where you pay a larger portion of your medical costs. Those who need expensive medical care or who have chronic illnesses should choose the most comprehensive coverage that’s available. Compare deductibles and out-of-pocket costs for your medications and the medical care you’re likely to use. If you have a lot of medical expenses, a plan with a higher premium but a lower deductible and coinsurance payments, such as a gold-level plan, might end up costing less by the end of the year than a lower-tier silver or bronze plan. Also compare the out-of-pocket maximum (the most you have to pay for in-network care).

This is typically a few plans from the same insurance company. Picking the best health insurance can feel overwhelming, and you typically have a limited window to make your choice each year. But it’s a critical decision, and choosing the wrong coverage can be costly. Sometimes you can get better service, and maybe even save money, if you don’t use your health insurance. Find out about new options that can make it worthwhile to pay cash.

• For more information about your options during open enrollment, whether you get insurance on your own or through your employer, see our Guide to Picking the Best Health Insurance for 2015.
• They’re also beefing up tools to help you compare prices — for example, showing the rates you’ll pay in your area that insurers negotiated with health care providers.
• But if you want to switch policies and have the new one start on January 1, you’ll need to sign up by December 15.
• Many insurers had several versions of their policies on the exchanges, some with lower premiums in exchange for smaller provider networks, a trend that is likely to continue for 2015.
• In Missouri, for example, the number of insurers selling on the state exchange is rising from three in 2014 to eight in 2015.
• Even if you liked your coverage over the past year, you may benefit from switching.

If you’re buying health insurance outside a job-based plan, you’re in luck this fall. You will have more time to sign up, more free help choosing a plan, and a greater likelihood you’ll be eligible for subsidies to help keep down the costs of a health plan you buy via the ACA marketplace. Employers picking the best health insurance for 2015 are also searching for ways to manage the rising costs of specialty drugs. They’re continuing to add hurdles before covering some expensive drugs. About one-third plan to require you to use a specialty pharmacy for certain high-cost drugs; such pharmacies specialize in helping patients manage medications for diseases such as Hepatitis C. “In many cases, these expensive drugs are breakthrough therapies for chronic, complex diseases,” says Marlo.

However, by limiting your choices to providers they’ve contracted with, HMOs do tend to be the cheapest type of health plan. Your out-of-pocket costs could rise significantly unless you follow some key strategies for smarter health care shopping. The biggest shock for many people may have been the small provider networks.

His team aims to get people in and out — enrolled in a plan — in an hour and a half. And those appointments don’t have to be in person — customers can get help by phone and can often do everything they need to do to get signed up virtually. For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act, also known as Obamacare. Asking yourself a few simple questions can help you zero in on the right plan from all those on the market. Look at the amount and type of treatment you’ve received in the past. While it’s impossible to predict every medical expense, paying attention to trends can help you make an informed decision.

What are your healthcare needs?

If your preferred physician or specialist or hospital isn’t included in the network of the plan, you’ll likely have to pay more to see them. Pay special attention to clauses regarding pre-existing conditions, such as diabetes. Most policies state that, for anyone with those conditions, the policy will only be active after a stipulated period of time.

“Your plan may no longer be the lowest-cost plan available to you,” says Cynthia Cox, of the Kaiser Family Foundation. You need to be particularly careful if your income is below 400% of the federal poverty level and you qualify for a subsidy to buy coverage on the exchanges. Whether you get your health insurance through your employer or on your own, compare your options and make sure you’re getting the most out of your coverage.