Starting November 1, 2016, you can sign up for 2017 Open Enrollment health insurance (with coverage starting as soon as January 1, 2017). So get ready with the few easy tips below:
- Does anyone in your household need regular prescription drugs? If so, how are they covered?
Each health insurance plan has a Prescription Drug List of covered medications. The drugs are grouped into cost levels, called tiers. The drug tier indicates the amount you pay for a prescription, as determined by your benefit plan. You’ll save money by using medications in tier one (lowest cost). Make sure your medications are covered in the commonly prescribed medications list in the Marketplace health plan.
- Are you anticipating any surgery in the family during the next year?
Most plans cover a major portion of surgical costs for procedures deemed medically necessary — that is, surgery to save your life, improve your health, or avert possible illness. Read the summary you received when you enrolled in your plan. Inside this booklet, insurance companies typically list covered and excluded costs for care. Contact your health insurance company if you do not have this information.
- Do you expect to have frequent visits to the doctor during the next few months or year?
If you have a family member who is pregnant or is prone to getting sick, undergoing treatment etc, you need to choose a plan that covers most of your needs and avoid exorbitant medical costs. This will not only give you the peace of mind to deal with emergency situations, but it will also reduce your family’s financial burden.
- Are your doctors in the plan’s network?
Check all of the information available to you—such as the provider directories–to ensure he or she is included in the network related to whichever plan or plans you are considering. The same holds true for any specialists–as well as hospitals, laboratories, imaging centers, and pharmacies–you may prefer. This is important because if your preferred physician or specialist or hospital isn’t included in the network of the plan you’re considering, you’ll likely have to pay more to see them than you would if you went to an in-network physician, specialist, etc.
- Does your family need dental or vision insurance?
Dental insurance is designed to offer you coverage for common dental care issues and to help you budget for dental services at all levels, preventive, basic and major. Vision insurance is designed to help you cover and budget for ongoing vision care expenses like routine eye exams, prescription glasses and contact lenses. If you or your family member has issues with dental or vision, it is better to take the respective insurances. This will help you prevent unnecessary emergency costs in the future.
- What type of plan will suit my needs?
There are five levels of coverage in the Marketplace: Bronze, Silver, Gold, Platinum and Catastrophic. Catastrophic plans do not meet the minimum requirements of the Affordable Care Act and are available only to those granted hardship exemptions and to those under age 30. Each level offers different coverage.
A Bronze level plan has higher out-of-pocket costs, but has a lower monthly premium.
A Gold level plan covers more of your out-of-pocket costs when you need care, but has a higher monthly premium. If your family expects to have a lot of medical expenses, this might be the plan for you.
- If your family anticipates a lot of medical expenses, you may want to consider a lower deductible plan.
- If your family is healthy and you expect few doctor visits, then a higher deductible plan will lower your monthly premium.
- If you have a healthy family and are looking for tax advantages, there are options for that, too.
- What are the limitations in your health plan?
Make sure you’re aware of what might not be covered. Common exclusions and limitations include elective or cosmetic surgery and alternative therapies.
- Does it cover pre-existing conditions?
Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre–existing condition” — that is, a health problem you had before the date that new health coverage starts. They also can’t charge women more than men.
- How much does it cost?
First, an important piece of advice to share here is to not focus on just the premium or deductible–the amount you owe for healthcare services before your plan begins to pitch in or take over–you’ll have to pay for a health insurance plan.
So, consider the coinsurance payments, which are your share of the costs related to a specific healthcare service after you’ve paid your plan’s deductible, or copay, which are the fixed amount you pay for a particular service, such as a doctor’s office or emergency room visit, you’ll be responsible for should you pick one plan over another.
Also, take some time to think about how much all of these costs, which may seem reasonable enough at first, could add up.
One last piece of advice related to all of this: if you’re young and basically healthy, the rule of thumb is to lean toward insurance policies with high deductibles, assuming you can afford them. Doing so likely will earn you a lower premium payment and should save you some money in the long run.
And if you’re on the opposite end of the spectrum—maybe you’re older, or you have a chronic or otherwise expensive-to-treat condition—you may want to focus on plans that have higher premiums, as they’re likely to cover more of your costs over time.
- Do you qualify for a subsidy?
If your income is below 400 percent of the federal poverty level, you might qualify for a subsidy. There are people who have got ACA health plans for as low as $50 per month because they were eligible for tax credits. According to the latest study by U.S. Department of Health & Human Services, “We estimate that about 2.5 million people enrolled in off-Marketplace individual market coverage have incomes that may qualify them for tax credits. In six states (California, Texas, Florida, North Carolina, Illinois, and Pennsylvania) more than 100,000 individuals enrolled in off-Marketplace individual market coverage have incomes that may qualify them for Marketplace subsidies.” So make sure you check about subsidy eligibility while enrolling in a health plan.
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