Content provided by Matthew Kubal, Mercer Insurance Services, Inc
‘Tis the season for holiday merriment…and fun things like open enrollment. At some point you’ve likely stared blankly at plan options, fretting that you might pay a fortune for a 15-minute doctor’s visit. Are you worried about finding a plan that covers your specific medications or health conditions? If these questions sound familiar, you’re not alone! It is easy to get lost in a wealth of options, jargon and technical terms, but with the right knowledge and support, you can find the best plan to meet your needs.
Key 1: Know Where to Start First
To find the right plan, start by looking in the right place. If you qualify for Medicare and Medicaid, those are often the best options. Next, consider employer-sponsored plans. While employer plans are usually your next best bet, don’t automatically assume it. Instead, compare your offer with alternatives like a spouse’s employer plan, the VA or the Marketplace. Families may also find value in splitting coverage.
If those options aren’t available, consider Marketplace plans (healthcare.gov). Be wary of off-Marketplace plans, as many do not meet minimum coverage standards and lack premium subsidies. Marketplace plans meet state and federal coverage standards (including free preventive care), offer premium subsidies, and do not exclude preexisting conditions.
Key 2: Assessing Your Needs
Pause to consider your family’s health care needs and priorities. Consider your preferred doctors, hospitals and prescription needs. What are your expected medical expenses such as urgent care, prescriptions and primary care visits for the next year? If you want to contribute to an HSA, make sure you choose an HSA-eligible plan. Make sure to reassess every year. When your needs change, your health insurance plan should evolve with it.
Key 3: Compare Your Options
With your needs identified and plans before you, narrow the list by considering your unique needs against provider networks, prescription drug coverage, and how costs are shared between you and your insurance plan (deductibles, copays, coinsurance). Start with the lowest premium plan that meets all of your needs and evaluate the value of any higher-premium options.
Balance out-of-pocket costs with the plan’s premium based on your health care needs to find the best value. For example, don’t pay $40 per month to reduce your doctor visit copay by $20 unless you typically have at least two visits per month. If you have a major surgery scheduled, choose a plan with a lower out-of-pocket maximum. If you have weekly counselor visits, choose a plan with a low mental health copay.
If you have expensive prescriptions, carefully review formularies and drug copays, and especially consider coverage before you meet your deductible. Factor in premium differences and explore cost-saving options like mail order, online discounts, and pharmacy comparisons.
Key 4: Seek Expert Guidance
Overwhelmed or not, you can ask for help, and it’s generally free. Contact your human resources department for employer plans, or the Indiana Family and Social Services Administration (Medicaid). You can also speak with a broker, the State Assisted Health Insurance Program, visit Medicare.gov, or find a local broker or navigator at healthcare.gov for questions about individual plans.
At the end of the day, one headache to navigate through benefit selection can lead to a wealth of affordable care.
