Two Key Factors in Choosing a Health Exchange Plan

by Cathy Miller on December 17, 2013

in Health Insurance

HC.govThere may be a glimmer of hope at Healthcare.gov.

  • Some individuals have gotten past the application process
  • Others have selected their new plan
  • And some are confused by the sheer volume of choices

A recent Twitter chat with writer friends reminded me how overwhelming health insurance can be.

I have an unfair advantage because I am a licensed health insurance broker. I don’t sell or service health insurance any more, but I maintain my license for my business writing.

So, I decided to put together some basic tips for choosing a health insurance plan on the federal exchange (marketplace), Healthcare.gov.

There are two factors to consider in purchasing health insurance – Money and Doctors.

Before We Start

My colleagues from Twitter and I have a few characteristics in common.

  • We are self-employed
  • We buy our own health insurance
  • We do not have coverage anywhere else (e.g., a spouse, Medicare, Medicaid, etc.)

If you share at least the second and third characteristics, then this post is for you.

I’ve admitted my bias before, but I strongly recommend you find a broker (if you don’t already have one). They will know how to find all the sneaky little terms in health insurance.

If you need help with insurance terms, this SlideShare presentation may help.

NOTE: This was created before Healthcare.gov went live. Where the presentation talks about individuals paying all the premium, the Affordable Care Act offers premium help to those who qualify.

Money – Figure Out What You Can Afford

I know. Easier said than done.

What did you pay last year?

Add it all. Check your tax return if you claimed medical expenses.

  • Total premium paid last year
  • Total amount you paid after your insurance paid its portion
  • If you didn’t have insurance – total you paid for health care

Then think about the following.

  • Did you struggle to pay your premium each month?
  • Did you have money for charges applied to your deductible?
  • How about other out-of-pocket expenses like coinsurance or copayments?

Before we apply this to your health insurance options, let’s look at the Doctors factor.

Doctors – Strangers or Part of the Family?

For many of us, selecting a doctor is personal. On the other hand, if you do not have a family physician or no affiliation with a particular medical group or hospital,you may have more options for your health insurance.

  • Is your choice of doctor or medical group non-negotiable?
  • Would you be open to receiving care from a smaller, limited network of doctors?

Many insurance carriers offer what is known as a narrow network as part of specific plans. Typically, the premiums are lower for those plans. The catch is, you have to go to that plan’s doctors.

How often do you see your doctors?

  • Do you primarily go for annual physicals only?
  • Do you have a condition that means you see your doctors multiple times?
  • Does your doctor prescribe medications that you take on an ongoing basis?

Time to Choose

Choosing the best health insurance plan for your needs is a bit of a gamble. Living without health insurance is a far greater risk.

So, let’ see what we’ve learned.

Money

  • If you have savings tucked away – Explore the plans with a higher deductible that typically have lower premiums. Your savings would be available (if necessary) to cover the high deductible.
  • If you have little or no savings – Look for lower deductibles and coinsurance (20% vs 50%) or out-of-pocket expenses. The downside is your premium will be higher.

Doctors

  • If you have a lot of doctor visits – You may want a plan with a higher premium to bring down the out-of-pocket costs of deductibles, coinsurance or copayments.
  • If your doctor prescribes ongoing medications – Look for health plans that have lower out-of-pocket expenses for prescriptions.
  • If you rarely take medications – A plan with higher out-of-pocket costs for prescriptions could mean lower premiums.
  • If you want to keep your same doctor – Be sure to check if the plan you select has your doctor in the network. You should see a link for the plan that has Network Details. Click on the link and enter your doctor’s (or the group’s) name in the search box.
  • If you are flexible on the choice of doctors – Check out plans with a limited network of doctors (they often refer to them as Select or Choice). The premiums are often lower. TIP: Your broker can help you identify the plans with a narrow network.

Easy, right? Not so much.

If you do use a broker, share these answers with your broker. They are helpful when choosing a plan.

I hope this helped. I’m sure my writer friends will let me know.

May the force be with you.

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Helping you Keep it simple, clear & uniquely yours – contact me for help with your business writing needs. Visit my business blog, Simply stated business.

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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.

{ 4 comments… read them below or add one }

Dava Stewart December 17, 2013 at 7:14 am

Thanks, Cathy, this post does help. My problem is that I understand all of this in an intellectual way, but there are just too many questions where the answer is “I don’t know.” My family hasn’t been insured for a few years. We don’t go to the doctor often (in large part because we don’t have insurance). We also don’t have savings, so if we have a high deductible plan, we’ll continue to not go to the doctor…

But, the advice to find a broker is golden. I had no idea until we chatted a few days ago that brokers even existed. Having someone explain the differences between options would be wonderful!

Thanks again for an informative, useful post!
Dava Stewart´s last blog post ..Matthew Hubbard Shares His Thoughts on WritingMy Profile

Reply

Cathy Miller December 17, 2013 at 7:24 am

I’m glad it helped a little bit, Dava. Healthcare.gov also offers what they call Navigators, but again my bias is brokers who have been doing this for awhile.

I’m not sure what state you live in. Some states are letting Healthcare.gov handle enrollment, while others have their own site. Again, that’s something a broker can help with.

Good luck, Dava!

Reply

Paula December 17, 2013 at 10:08 am

I’ll be discussing options with my broker this week, Cathy. I learned I’m eligible for a partial subsidy, which will really cut my monthly costs – so whichever plan I choose I’ll pay less for more.

My state uses the healthcare.gov site, and my big issue was that it’s not very Mac compatible – or so said the 4th or 5th representative I spoke with. That was the day after another rep said my application was submitted and I was ready to go and told me my eligibility notice would be viewable within 24 hours. The site told me I had two messages waiting, but there were no links that would lead me to those messages. Somehow I’m supposed to remember everything they told me on the phone – they said, “Oh, you don’t need to read those anyway.” Right.

Maybe my broker can get in to view them?

Next step: Choosing the plan. Thanks for the tips, Cathy.

Reply

Cathy Miller December 17, 2013 at 10:24 am

Let me know how it goes with your broker, Paula. I had all kinds of issues with being unable to access the notices. The final straw was when the rep told me he couldn’t access them either and there was nothing he could do about it. Well, isn’t that great customer service?

I went another route. I was trying to access the site from an educational point so I could share tips here. I am glad you found these somewhat helpful, Paula.

Good luck!

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