The world of healthcare can be confusing and, quite honestly, overwhelming when trying to pick a plan.
And once we find the plan, navigating through providers and premiums presents a new set of challenges. Top that off with a bit of uncertainty for what 2017 and a new president could mean, and you’re probably about ready to pull your hair out while trying to pick the best health insurance for you and your family.
If you’re still asking yourself “What’s the best health insurance plan for me?,” you’re not alone. Many people will be changing insurance carriers, adding benefits, and even adding new family members to their plans during open enrollment. The last thing anyone wants is for these changes to unnecessarily cost them extra money. But choosing a health insurance plan doesn’t have to be so confusing.
Read on to find out which questions you should be asking when picking your new health insurance plan for 2017.
Two easy ways to save money on your health insurance are to exercise and eat healthy food, like these coconut oil recipes!
How do I know what type of plan is right for me?
There are a variety of types of medical insurance plans you can buy into. Whatever the plan may be, it’s important to compare the following features of each plan:
• Annual premiums
• Any co-payments or co-insurance
• If your doctor is in the plan’s network
You may also have to decide between an HMO, PPO, HDHP, or PSO. Here’s a quick explanation of what all these acronyms mean:
A Preferred Provider Organization, or PPO, is a type of medical insurance plan for individuals and families. These plans let you see whatever in-network doctors or healthcare providers you would like without necessarily getting a referral from a primary care doctor. But you should always check with the individual plan to find out if there are any specific requirements to choosing a provider.
Health Maintenance Organization plans (HMOs) require participants to choose a primary care physician from a specific network of local healthcare providers, which will refer you to in-network specialists or hospitals. Your care will be coordinated through your primary care physician, including referrals from them to see specialists.
A POS, or Point of Service plan, works as a managed care plan. Think of it like a combination of an HMO and PPO plan. If you have a POS plan, you’re able to go outside your provider network for health care services like you can with a PPO, and also pick an in-network doctor to be your primary care provider just like an HMO.
HDHP, or High-Deductible Health Plan, is a plan with lower premiums and higher deductibles than a typical health plan would have. These plans are intended as a form of catastrophic coverage, so you might use one if you’re in good health and don’t foresee needing to see your doctor for anything other than your regular annual checkup. Another thing to note is that choosing an HDHP is also a requirement for having a Health Savings Account, or HSA.
What other things should I look for when choosing health care coverage?
Find out what your prescription coverage will be and, if you’re currently taking medications, find out if they offer some type of prescription program where you purchase the medication through their supplier.
Be sure to find out all the details about emergency care costs, as well as routine and preventative care, mental health coverage, and pediatric coverage if you have children. You should also check to see if the plan includes vision coverage.
What are my deductibles?
Often you’ll have deductibles for different areas of care. This deductible is the amount you must pay out of pocket before your insurance plan kicks in and begins to cover costs for you. Usually the higher the deductible means the less you pay for your annual premium cost.
You should find out the exact amounts you’ll be charged for various areas of care —emergency care, preventative care, and prescriptions are a few places to start.
What’s the difference between an FSA and an HSA?
A health flexible spending account (FSA) allows you to use pre-tax dollars to pay for eligible health care expenses for you, your spouse, and any eligible dependents. Money is set aside from your paycheck before taxes are taken out, and you can use an FSA with any kind of health insurance plan.
These accounts are included as part of your benefit package, and the advantage is you will be spending pre-tax dollars. However, one disadvantage may be that if you don’t use all the money set aside, you lose it. So be sure to ask what happens to dollars that are left in the account at the end of the year.
A health savings account (HSA) acts as a medical savings account where you, and your employer, can make tax-deductible contributions to your HSA account. You can then use the money in your HSA to pay for eligible medical costs that have to be paid out of pocket — the IRS has put together a list of qualified expenses here.
One advantage to an HSA account is that your money can be rolled over and used next year. However, two things to keep in mind are that not all employers offer a contribution, and there’s an annual contribution limit based on the level of health care coverage.
Optum Bank also offers a quick breakdown and comparison of FSA and HSA plans here.
Can I negotiate my medical bill?
Don’t assume all hospitals and doctors charge the same rates! Take the time to compare hospitals, doctors, and additional procedure charges.
If you live in an area where the hospital is also a teaching institution, they may have a different rate than a private hospital. Find out if they offer payment plans and always make sure you find out which costs your insurance will cover. Most hospitals will allow you to set up a payment plan and if you are low-income they may even have assistance programs.
If you need to get an idea of what the ballpark should be for charges, Medicare has fairly standard rates and can be a guide for you.
What is COBRA?
If you’re leaving a job where you’re covered under a medical insurance policy, you should be given an option to continue medical coverage under COBRA. You’ll have to pay the premium yourself and often times it’s higher than what you were paying as an employee, but you won’t have to worry about paying a penalty for not having health insurance. For more detailed information check out the COBRA website.
What is CHIP?
If your family earns too much money to qualify for Medicaid but you’re unable to cover healthcare costs for your child, you can look into CHIP. This program provides low-cost healthcare coverage for children, and depending on the state you live in it may also cover you if you’re pregnant.
Every state works with Medicaid and should offer CHIP coverage. Check out the Healthcare.gov website to find out more about CHIP.
How long can my child stay on my health care plan?
Your child can stay on your health insurance plan through age 26.
Should I sign up for an ACA plan even though the ACA might be changed or repealed in 2017?
This is a question on many American’s minds this year as we wait for the new president to take office in January. One thing to keep in mind is that even if Congress and the new president decide to change or repeal the health insurance marketplace, it could be a very time consuming process, which means your ACA plan will most likely last through 2017, says U.S. News.
If you’re reluctant to sign up for healthcare but can afford it, keep in mind there may be tax implications. For the 2016 and 2017 tax years, the penalty is $695 per adult and $347.50 per child under the age of 18 with a maximum of $2,085 — or 2.5 percent of your income, whichever number is higher. Check out all the rules and fees for the health care tax penalty here. If you do find yourself in this situation, it’s always a good idea to ask a tax professional because every taxpayer is in a different situation.