How To Pick A Health Insurance Plan: 6 Expert Tips : Shots – Health News : NPR

How to shop for medical insurance

Video How to shop for medical insurance

It’s the season to roll up your sleeves, gather your paperwork, and choose a 2020 health insurance plan. For those shopping for their own plans, healthcare.gov and the other state exchanges are open for enrollment beginning November 1.

Despite the rhetoric about the Affordable Care Act imploding, the removal of the individual mandate, and other attempts to stifle the law, markets are still alive and well. And many people are eligible for subsidies to lower their costs.

In fact, healthcare.gov has gotten more elegant and user-friendly over the years (after a famously rocky start). there are new bells and whistles to make buying a plan easier this year. Still, it’s hard to figure out how to balance premiums, deductibles, and other costs and choose a plan that will fit your needs for next year.

charlene wong knows this from experience. Even as a doctor and scholar at Duke University who studies how people make health insurance decisions, she and her husband chose the wrong plan a few years ago.

“We spent several days researching plans and calling to make sure the doctors we wanted to see were in network,” she says. she then got pregnant and discovered that while her obstetrician was on the network, there was a problem.

“There was a tiered network within that health insurance plan, and [my obstetrician] was in tier 3 of network providers,” she explains. Even though she thought she had done everything right, she ended up having to change doctors to keep her costs down.

so take heart: health insurance can be complicated, even for experts. here are some tips to help you find the right plan.

1: Find out where and when to sign up

Depending on where you live, you can use the federal exchanges at healthcare.gov or your state’s marketplace to buy insurance. Twelve states and the District of Columbia operate their own exchanges. Federal exchange open enrollment runs through mid-December, but you may have longer if you live in a state that has its own marketplace.

2: Review plan options, even if you like the current one

for people who are already enrolled in an aca plan, charles gaba says it’s very important to log in and check for a better value, even if you’re happy with your current plan. Gaba runs the website acasignups.net, where she does health care policy and data analysis, primarily focused on the Affordable Care Act.

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It can be tempting to skip the whole enrollment hassle, especially since you’ll simply be transferred to the same or a similar plan if you do nothing during open enrollment.

“A lot of people think that because nothing changed in their lives, like their income is the same, the same home, nothing will change in their policy or their premiums, and that’s just not true,” says Gaba.

Each year, there can be all kinds of changes that affect the types of plans available and the costs of those plans. for example, new insurers have entered the market this year and premiums have dropped in some states. It’s always worth logging in and checking what’s changed for you and whether it makes sense to change things.

3: Compare estimated annual costs, not just monthly premiums

It’s easy to focus on your monthly premium payment when comparing plans, but wong at duke says don’t forget to consider other costs as well.

“Many people (we know from previous research) focus too much on the monthly premium and may not pay as much attention to things like the deductible or the amount of copays,” says wong.

The premium price stands out when you’re looking for plans, but keep other costs in mind as well. a tool available on healthcare.gov and some state marketplaces will calculate “estimated total annual costs” for you. this takes into account the plan’s deductible (how much you have to pay out-of-pocket for covered services before your insurance pays the bill) and copays, along with how much health care you expect to use in the next year.

wong says the annual cost estimate can be a very useful tool when choosing a plan. “try to realize that the math can be a bit tricky, especially for people who are not that familiar with health insurance.” she says.

4 – consider how much health care you use

Choosing the right insurance plan involves guesswork about how many health problems you’re likely to face in the coming year, which could affect how costs are broken out. Your age is often a helpful indicator for this, but there are always plenty of unknowns, like a surprise cancer diagnosis or a car accident.

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wong points out that there are basic trade-offs to consider. “You might want to think, ‘Do I pay a little more each month in a monthly premium knowing that would mean lower out-of-pocket costs when and if I need more medical care?’ she says. “versus, the other way around, ‘let me pay a lower monthly premium because I don’t really anticipate needing a lot of care, but I know I’d have this health insurance in case something really catastrophic happens.'”

Along with these unknowns, take advantage of what you know about your health needs. If you have a doctor you like, or you know you’ll be taking a certain prescription drug, find a plan that covers it. healthcare.gov allows you to add your provider and your prescriptions as you search for plans to see if they are covered. another way to find out is to simply call your doctors and ask what plans they accept, wong says.

5 – beware of plans that are too good to be true

If you see a good deal online, be sure to shop for a plan here, warns health policy writer and insurance broker Louise Norris. When you search for health insurance online, you may find short-term plans that advertise much lower monthly premiums, but don’t cover the famous 10 Essential Benefits of the ACA. These include some pretty important things like prenatal care and mental health treatment.

People can sometimes find good deals on premiums in the federal and state markets, Norris says, but if a plan stands out as too good to be true, read the fine print.

“I saw some new plans come out in some areas for 2020 where they will say $0 deductible,” she says. “Then it shifts down a little bit more and you have maybe a $1,000 copay per day for hospitalization.” She hopes she doesn’t spend a lot of time in the hospital, but if she does, that kind of cost could really add up.

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norris highlights a new tool this year to help distinguish good plans from bad: a star rating, similar to what consumers are used to on yelp or amazon (recalling Obama’s original vision). star ratings are based on information submitted by insurers regarding cost, combined with member feedback.

“star ratings are one of those at-a-glance things where you can see, ‘OK, how do other customers feel about this plan?’ Norris says. Not all plans have them, as some are new, he says, but for plans that do, the stars “give you some red flags if maybe there are some concerns.”

6 – get free help from professionals

The trump administration cut federal funding to advertise open enrollment and the navigator program, but those programs still exist: there are still people across the country trained and ready to enroll people, for free.

“My best advice to people, especially those who are less familiar with insurance, is to see if you can get help,” says wong. she can call for help, but she recommends trying to meet in person with “a health insurance navigator or certified application counselor,” she says. “Most importantly, these are people who are unbiased about which health insurance plan may be best for you.”

katie turner is one of those skilled navigators: she’s been enrolling people for seven years and works with the family health care foundation in the tampa bay area, fla. Prior to open enrollment, she has been busy calling consumers for the past few years, letting them know that now is the time.

advises people to gather all necessary documents, such as social security cards, immigration paperwork, tax returns, before meeting with a navigator.

Above all, he says, don’t miss out on signing up for coverage if you need it.

“There’s a lot of confusion,” Turner says. Many people are confused about what a legal challenge to the law means for markets (nothing for now), when is open enrollment, and more. “All we can do,” says Turner, “is continue to be here and provide the resources that we’ve been providing for the last seven years to help people sign up for coverage.”


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