Picking a healthcare plan can be a nerve wracking endeavor. You have to balance what you can afford in monthly premiums, co-pays, and annual deductibles, while trying to make sure you have enough healthcare coverage that you don’t dread a trip to the doctor.
This is tricky for everyone, but often more difficult for people without employer coverage who are navigating the open marketplace in search of the right healthcare plan.
With this in mind we talked to experts about what you can look for in a health plan so that it can provide enough coverage without being overly taxing on your wallet.
And this is the perfect time to find a plan that fits your needs and saves you money, since open enrollment for plans on the federal exchange starts November 1.
What to know about the rise and fall of premium cost
The average premium for the benchmark healthcare plan on the Affordable Care Act health exchange is expected to drop by 4 percent next year, reports CNN.
This is compared to annual premiums for family health coverage obtained through an employer. Those premiums are up 5 percent from last year, reports the Kaiser Family Foundation.
Other out-of-pocket expenses are also on the rise, including deductibles for employer coverage. This is the amount you have to pay before your insurance begins covering most services.
The news that premiums are down for plans on the ACA healthcare exchange is good news for anyone who doesn’t qualify for employer coverage, Medicaid (for lower income), or Medicare (those 65 years and older).
If you want to lock in these savings, you’ll have to act soon.
The open enrollment period for the federal HealthCare.gov and state insurance marketplaces runs from November 1, 2019 through December 15, 2019.
This is a fact that apparently 88 percent of Americans may not know. But it’s crucial to keep that timeline in mind if you’re interested in getting your plan from the open marketplace.
If you miss the deadline, you’ll have to wait until next year to apply, unless you qualify for a special enrollment period. This applies to major life events like having a baby, getting married, or losing your health coverage.
Navigating the sign up process and comparing healthcare plans can be complicated, so it’s best not to wait until the last minute to start.
Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation, recommends that you “give yourself a few hours to really look over the different plans.”
Also, if you’re a little fuzzy on the difference between premiums, deductibles, copays, and coinsurance, you might want to brush up on your health plan lingo. This Healthline tutorial will help you become fluent in no time.
Consider your health needs
Before you start comparing healthcare plans, think about what your and your family’s health needs will be over the next year.
Dr. Nancy Nielsen, MD, PhD, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences said you can’t predict if something bad is going to happen, like getting hurt on a ski slope or being diagnosed with cancer.
“But in general, you can pretty much gauge it based on what your family’s needs have been in the past,” she added.
For example, if you have little children, they will need to go to the pediatrician fairly often. Or if you’re pregnant, you’ll need prenatal care. These are both fairly inexpensive situations.
“If, on the other hand, somebody in your family has a serious illness,” said Nielsen, “then the chances are that your costs for medical care — total costs — are going to be pretty high.”
To estimate what healthcare you’ll need, ask yourself the following questions. If you have a spouse or children, ask the same questions about their health situation.
“Once you have all that figured out,” said Donovan, “then you can really take a look at what type of plan you need.”
There are four categories of health plans: Bronze, Silver, Gold, and Platinum. They differ in how much of your medical costs you have to pay out of pocket.
You get the same quality of care in whichever plan you choose.
Choose the “best” plan for you
When you start comparing healthcare plans, it can be tempting to choose the one with the lowest premium, or monthly cost.
While this is an important thing to consider — especially if you earn less money — lower-premium plans come with tradeoffs.
“Insurance plans that have the lowest premiums basically have a higher risk. They tend to be the plans with a higher deductible. They tend to have significant out-of-pocket expenses,” said Dr. Nicole Rochester, founder of Your GPS Doc and author of “Healthcare Navigation 101: A Guide for College-Bound Students (and Parents!).”
This is where your estimated healthcare needs comes in.
People with higher medical costs “probably would benefit from spending a little bit more money on the front end with a slightly higher premium, but choosing a plan that has a lower deductible and lower out-of-pocket expenses,” said Rochester.
For example, if you need ongoing tests like MRIs or CT scans, you could save money by choosing a plan with a higher monthly premium, but a lower deductible.
Likewise, if you make frequent visits to your primary care doctor or specialists every year, you might want to choose a plan with a low co-pay for these visits.
For some — like healthy, young people — a high-deductible plan may make sense. If you fall into this category, keep in mind that all it takes is one bad car accident or surgery to reach your deductible.
Young people are sometimes “shocked when they go to the hospital and they’re responsible for all of the costs up to their deductible, which is often in the multiple thousands,” said Rochester.
Once you’ve settled on a plan, check to make sure your current doctor is included in the provider network.
Insurance companies usually have an online list of providers that are included in each plan’s network. But Donovan still recommends calling your doctor’s office to confirm that they’ll be “in network” for the upcoming year.
Save on healthcare in other ways
Nielsen said depending on your income and family situation, you may also qualify for Medicaid, a premium tax credit, or extra savings on costs such as deductibles, copayments, and coinsurance.
HealthCare.gov or a state marketplace website will guide you through these options.
Another way to save on healthcare is with a Health Savings Account, or HSA. This account lets you set aside money on a pre-tax basis to pay for medical expenses.
“If you can afford a health savings plan — and that’s a big if — I highly encourage them, for a lot of reasons,” said Donovan.
You can only contribute to an HSA if you have a high deductible healthcare plan.
But you can use the HSA to pay for deductibles, copayments, coinsurance, and some other expenses — although not usually premiums — for both yourself and your dependents.
Also, “there are a lot of instances where you can use an HSA for things that aren’t traditionally covered by your plan,” said Donovan.
This includes things like dental braces, fertility treatments, and chiropractic care.
Donovan said that because HSA funds roll over year to year, if you don’t spend them, you can also use them as a kind of “alternative retirement plan.”
With the average couple needing $280,000 to cover their healthcare costs after they retire at 65, an HSA can bring a little security to their golden years, according to Fidelity.
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