Put Health Insurance Open Enrollment on Your Fall To-Do List
ON BEHALF OF MEDICAL GROUP OF THE CAROLINAS—MOUNTAIN PARK
Fall doesn’t just mean cooler temperatures, leaves changing colors and football. It’s also open enrollment time for health insurance plans.
Understanding your health insurance policy and comparing your options may seem complicated and daunting, but here are some tips that should make it simpler.
Affordable Care Act
The ACA, or “Obamacare,” aims to get more Americans covered and offers a Health Insurance Marketplace (healthcare.gov) where small businesses and individuals can purchase a policy.
- Open enrollment takes place from Nov. 1 to Dec. 15 for plans that start Jan. 1, 2017.
- Many people qualify for subsidies that reduce out-of-pocket costs.
- The marketplace offers four levels of coverage – bronze, silver, gold and platinum ‑ determined by how costs are shared. To determine which level fits your needs, go to www.healthcare.gov/choose-a-plan/plans-categories.
- The ACA requires people to have “qualifying health coverage,” and those who don’t have health coverage face a penalty (a fee) when filing taxes.
You will need Social Security numbers, income details and last year’s tax documents to sign up.
For details or help, visit healthcare.gov or call 1-800-318-2596.
Check your coverage
For those who already have health coverage, the first step during open enrollment should be to review your current plan so you can compare it with plans offered the next calendar year. The following items are important factors to take into consideration:
- Monthly premiums
- Covered services
- You should also think about how well your plan worked for you and your family in the past year
Was your deductible too high?
- How much did you pay for an average doctor visit?
- Were you unable to see a particular doctor or go to particular facility due to them being out of network?
- Were you satisfied with the prescription drug coverage?
- How often did you use your insurance?
- Did your insurance deny claims?
- Next, check and see if your current plan is changing for next year and compare it to your other options. Some key things to check might include:
- Are your doctors in the plan’s network?
- Is your preferred hospital in the network?
- Are your prescription drugs covered?
- Are treatments (physical therapy, mental health visits, etc.) covered?
You can find this information on the insurance company’s website or by calling customer service.
Personalize your search
Always keep your family’s particular needs in mind when choosing health coverage. For example, planning for a knee replacement surgery might need to pay close attention to hospital stay cost and physical therapy coverage.
According to Consumer Reports, those with expensive medical conditions might look at plans with a higher premium that covers more, while those who are “generally healthy” might want to buy coverage with a lower premium that requires more out-of-pocket costs for care.
If you have more questions about choosing health coverage, the National Health Council has compiled many helpful sites. Visit them at www.puttingpatientsfirst.net/answer-my-questions.