Choosing the right health insurance plan each year is an anxiety filled, complicated and overwhelming process.
You get a couple of weeks or, if you’re lucky, a few months to go over multiple options either provided through your employer or on the federal marketplace. That means sorting through terms like deductible, co-insurance and HSA that even experts have a hard time comprehending.
So you might just go with what you had last year, even if it might mean you end up spending more money than necessary or leave yourself open to a huge financial risk in the event of an unforeseen emergency.
We can’t make the process any less complicated. But the Kansas News Service spoke with a few experts for tips.
Prepare
The first, and most basic step, is to know when your open enrollment period begins.
Many private employer-based health insurance plans open enrollment around October.
For those who get their health insurance from the federal marketplace, the open enrollment period begins Nov. 1 and runs through January 15.
Julia Voss is a certified application counselor with Project Access in Sedgwick County. She said it’s important to begin looking at healthcare.gov plans as soon as you can.
“You may have some questions that you need to investigate and do some more research on, so the earlier you do that the sooner you’re going to be able to make a good decision about meeting your needs,” she said.
It’s also important to recognize that choosing a health insurance plan will take effort. It might help to think about making health insurance selections the same way as you think about doing your taxes every year.
“Except you can pay someone to do your taxes for you,” said Emily Vardell, an assistant professor at Emporia State University who studies health insurance literacy. “You really can’t pay someone to pick your health insurance.”
Sure, both are a chore, she said, but with a little effort or some outside help, you can end up saving yourself a lot of money.
Reflect back
Before knowing what coverage will be best moving forward, it’s good to know how you’re already using the coverage you have.
Do you go to the doctor often? Is there a specialist you need to see? How many prescriptions do you need filled?
Vardell said looking at your previous usage will give you a better understanding of how much you actually spend, which could influence whether you choose a plan with a higher deductible and lower monthly premium or vice-versa.
She said you can find the information at your online health insurance account, looking at the statements sent to you in the mail, or even just back at your calendar.
Plan ahead
Next, ask yourself if there’s any medical procedures you can plan.
Do you have a chronic condition? Are you planning on having a baby? Or knee surgery?
If so, you might consider changing to a plan with a lower deductible or coinsurance, even if it means paying a higher monthly premium.
“That’s kind of the beauty and the pain of health insurance,” Vardell said. “You have to pick every year, but at least you can change it to fit your needs.”
Voss, the application counselor, said it’s also important to look at the details of plans, especially really low-cost coverage.
Some plans only allow you to see a doctor once every three months, she said, and if you have three or four doctors you see regularly that’s probably not going to be the best plan.
Get help
All of the experts we spoke with said don’t be afraid to use any and all resources available.
If you’re on an employer-sponsored plan, reach out to your human resources manager. At larger companies, they’ll often have events or webinars that will explain the options and give people the opportunity to ask questions. They’re worth your time. The wrong call on an insurance plan can mean a difference of tens of thousands of dollars.
If you’re selecting a plan through the federal marketplace, Healthcare.gov has a find-a-navigator tool. This will allow you to find people in your area, like Voss, who are trained to help people through the application and selection process.
Many other local and state agencies and nonprofits can answer questions about Medicaid and Medicare eligibility and application processes.
There are also several online tools, including JustPlainClear.com which allows you to look up the meaning of terms such as deductible, coinsurance and HMO.
Voss also suggested asking people in your trusted circle, including friends and family members, about how they make health insurance choices and whether they’ve liked a certain aspect of a plan or not.
Anything is better than nothing
Katherine Baicker is a health economist and the dean of the Harris School of Public Policy at the University of Chicago. She said whatever you end up deciding, just do something.
“Being insured is much better than being uninsured,” she said.
Even if you have a high deductible plan that leaves you paying out of pocket for most of your health care costs, it’s better than not having insurance at all. It could be your last defense against financial ruin.
For instance, Insurers will often negotiate discounts with providers. That means the price you’ll pay, even if you still haven’t met your deductible, would be less than the non-insured rate the provider charges.
For young, healthy people, she said that choice can be hard because spending any money on a health premium can seem like a waste.
“But It wasn’t wasted, you might have gotten sick.” Baicker said. “And you had that protection whether you ended up using it or not in the same way that I have homeowners insurance and every year that my house doesn’t burn down, that’s a good year.”
Ultimately, even a low-cost plan can protect against catastrophically high expenses that can come from an accident or a surprise diagnosis such as cancer.
In the end, the experts all said that the system is probably a lot more complicated than necessary, but until that changes, it’s worth it to try to understand how you can make it work best for you.
“It can be empowering to say I’m not going to let the insurance company take advantage of me,” Vardell said. “I’m going to make a decision that’s going to help my family save money.”
Brian Grimmett reports on the environment, energy and natural resources for KMUW in Wichita and the Kansas News Service. You can follow him on Twitter @briangrimmett or email him at grimmett (at) kmuw (dot) org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.
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