Trying to figure out the right health insurance plan often seems like the word problems we faced on high school math tests.
If Insurance Plan A has a premium of $440 a month, an annual deductible of $500, an annual out-of-pocket maximum of $2,000, and an office visit co-pay of $20 per visit and Insurance Plan B has a premium of $256 a month, an annual deductible of $1,500, an out-of-pocket maximum of $3,000, and an office visit co-pay of $30 per visit, which plan provides the best benefits at the lowest cost for a 62-year-old colorectal cancer survivor?
It’s enough to make your head spin.
But with the open enrollment period for the Health Insurance Marketplace set to end on February 15, 2015, these decisions have to be made. And soon! Otherwise you could face a penalty of 2% of your yearly household income or $325 per person, whichever is higher, if you are uninsured during 2015. Even if you received coverage through the Health Insurance Marketplace last year, now is the time for you to renew or change your plan for 2015.
Although this process can be complicated, choosing the right insurance plan is hugely important to make sure that you get the care you need at a cost you can afford. Here are a few helpful hints for navigating this process.
10 Tips for Getting the Most Out of Your Plan
1. Be ready to put in the time. According to Joe Keenan, a cancer survivor, looking for the right insurance plan on the exchanges can be a “six-to-nine job.” He says, “You have to actually block off the time and plan for multiple sessions of really digging in to what the offerings are.”
2. Have a pen and paper ready. Comparing health insurance policies can be a non-linear process. It is often helpful to spread all of the information out in front of you so you can see everything and make notes.
3. Attend informational sessions both in-person and online. Briefings and webinars are often offered through resources like support groups, non-profit organizations, and your chamber of commerce. There are also a number of local organizations that can answer your questions and help you pick a plan and enroll.
5. Make sure your current providers are “in network.” This means that your doctor, oncologist, and other specialists, as well as your hospital, are on the insurance plan’s approved list. If they aren’t, you will need to find new providers who are or be willing to pay costs associated with going “out-of-network.” HealthCare.gov provides a list of tools that can help you search and compare providers, hospitals, and other health care facilities to help you make these decisions.
6. Compare all aspects of the plan, not just the premium. Premiums are the amount you pay each month for your insurance coverage, whether you use any medical services or not. However, there are a number of other costs that are important to look at before enrolling.
- Deductible—the amount of money you must pay each year before the health care plan begins paying any costs
- Coinsurance—the percentage of health care costs you have to pay after you have reached your deductible
- Copays—set fees you are required to pay each time care is received, such as a doctor’s visit or trip to the emergency room
- Out-of-pocket maximums—the maximum amount you would ever have to pay from your personal financial resources during the year
In general, the lower your monthly premium, the higher your out-of-pocket costs will be when you need care.
It’s also important for people with cancer to consider things like:
- What medicines are covered? For example, are both IV and oral chemotherapy covered? At what cost?
- Are home care and therapy services included?
- Are follow-up procedures included, such as colonoscopies?
- What treatments related to your cancer care are covered, such as integrative medicine or fertility preservation?
7. Ask a trusted friend or family member for help. This could mean having someone else make phone calls or just having someone there to help you talk through and make sense of your options.
8. Establish a relationship with an insurance broker or a navigator. These professionals have the knowledge to tell you which plans will offer you the best return on your investment and help you narrow down your options.
9. Talk with a customer service representative from HealthCare.gov. The Marketplace Call Center is available 24/7 to answer your questions and help you start or finish an application, compare plans, or enroll.
10. Review your plan every year to make sure it is still working for you. As your health changes, your insurance plan may need to as well. Also, costs change and new plans are added to the exchanges each year.