When it comes to how to pick the best health insurance plan, the premium is the most important factor for many shoppers – especially those who are currently healthy. But price shouldn’t be the only factor upon which you base your selection, even if your primary concern is financial (as opposed to factors such as provider networks, drug formularies, and quality ratings).
Still, picking health insurance can be hard work, even if you’re choosing a plan through your employer. There are a lot of confusing terms, and the process forces you to think hard about your health and your finances. Plus you have to navigate all of it on a deadline, often with only a few-week period to explore your options and make decisions.
Whether you’re aging out of your parent’s plan and picking one for the first time, or you’re in a plan that no longer works for you and you’re ready to switch things up, or you’re uninsured and want to see if you have any workable options, there’s good news. Asking yourself a few simple questions can help you zero in on the right plan from all those on the market.
Here are some tips on where to look and how to get trustworthy advice and help if you need it.
1.Know where to go
It’s not always obvious where to look for health insurance. “In this country it is a truly wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.
If you’re 65 or older, you’re eligible for Medicare. It’s a federally run program — the government pays for much of your health care. You might also be eligible if you have certain disabilities. For those already enrolled in Medicare or in a Medicare Advantage plan, the open enrollment period to switch up your supplemental health and prescription drug plans for 2022 runs through Dec. 7 this year.
For those under age 65, Corlette says, “the vast majority of us get our coverage through our employer. The employer typically will cover between 70% and 90% of your premium costs, which is pretty nice.” Check with your supervisor or your company’s human resources department to find out what, if any, plans are available to you through your job.
Then there’s Medicaid, the health insurance program for people with low incomes, that covers around 80 million people — nearly one in four Americans. It’s funded by both the federal and state governments, but run by each state, so whether you’re eligible depends on where you live.
For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act, also known as Obamacare.
This is where you look for health insurance if you don’t fit any of the categories we mentioned previously, Corlette says — if, for example, “your employer doesn’t offer you any coverage; you’re not eligible for Medicare because you’re not old enough; and you’re not poor enough for Medicaid. You can go to the marketplaces, apply for financial help depending on your income, and choose a plan there.
2. The right plan for your age/health
If you’re relatively young and healthy, consider choosing a policy with a high deductible, the amount you must pay out of pocket before certain benefits kick in. A plan with a deductible of $1,000 or more is likely to cost you considerably less per month, and could save you money in the long run. If you middle aged or older, and things just don’t work the way they used to, consider a plan that would address those issues, with a slightly lower deductible – because you know you are for certain going to use it. Do the math. Add your deductible out-of-pocket cost to the monthly cost of the plan – are you ahead at the end of the year if you use your coverage consistently?
3. Learn what a few of those wonky health insurance terms mean
How much can you afford to pay for health insurance every month? In order to compare the true overall cost of health plans and figure out which one might work best within your budget, you need to get familiar with several important insurance terms — words like premium, cost-sharing, deductible and copay.
Luckily, we made a handy health insurance glossary just for you.
Insurance companies use these different types of charges — the premium vs. the deductible, for example — sort of like dials to keep their own costs manageable. A basic plan they sell might dial down the monthly premium on a particular plan, so it looks inexpensive. But that same plan might have a high, “dialed up” deductible of, say, $6,000 — meaning you’ll have to spend $6,000 out of your own pocket on health services each year before your insurance begins to pay its portion of the cost. If you picked that plan, you’d be betting you won’t have to use a lot of health services, and so would only have to worry about your — hopefully affordable — premiums, and the costs of a few appointments.
If you have a chronic medical condition or are simply more risk averse, you might instead choose a plan that has dialed up the amount of the premium. You’ll be forking over quite a bit more than for the other plan every month, but your costs will be more predictable — you’ll likely have a lower deductible and lower coinsurance rate. That way, you can go to a lot of appointments and pick up a lot of prescriptions and still have manageable monthly costs.
Which plans are available and affordable to you will vary a lot depending on where you live, your income and who’s in your household and on your insurance policy. With the pandemic, Congress passed new temporary funding to cover more out-of-pocket costs for people — depending on your income, you may qualify for plans with premiums of $10 or less per month on HealthCare.gov or onyour state’s ACA insurance exchange.
4. Check the network
If you have a primary care physician and specialists you like, be sure they’re in the network of any plan you consider buying. Policies generally cover a lower share of the cost of out-of-network care—or none at all. R&R Insurance can supply you with links to the plan’s network of physicians to help you in your decision making.
5. Coverage for a spouse or dependents
An “individual” plan, again means that it isn’t connected to your employer, but it can cover multiple people. Make sure you factor in the needs of your spouse, their age, affordable deductible etc. If you have children under age 26 without health insurance coverage through an employer, the law permits them to be on your insurance. Policies also can no longer exclude kids under age 19 from coverage because of pre-existing conditions.
6.Beware too-good-to-be-true plans sold online
The internet can be a scary place. Corlette says she warns people: Don’t put your contact information in health insurance interest forms on random websites or click on online ads for insurance!
The plans that tend to crop up when you Google “I need health insurance” can seem appealing because they’re often very cheap — but they might also be “short term” plans that don’t cover basic things like prescription drugs or annual check ups. Many experts warn that this type of plan is not a very good deal.
“Unfortunately, there are a lot of con artists out there who take advantage of the fact that people recognize health insurance is something that they should get,” says Corlette. She tells people: “Just go straight to Healthcare.gov. No matter what state you live in, you can go through that portal.” Any plan you find there will cover the ACA’s 10 essential benefits — such as free preventive care and hospital coverage.
7.Know your deadlines
Usually you only get a few weeks in the fall to sign up. This year, the sign up period for the HealthCare.gov marketplace plans that go into effect in January 2022 starts Nov. 1, 2021 and runs until Jan.15, 2022. If you’re signing up for an employer-sponsored plan or Medicare, the deadlines will be different, but probably also in the fall. For Medicaid, you can enroll at any time of the year.
DeLaO, the health navigator, says even if you’re already enrolled in a plan that seems fine and it’s tempting to just let it automatically renew, it’s always a good idea to annually check what else is available.
“Are you eligible for additional subsidies to lower the cost of your monthly premium?” he says. “Is there a plan that — with those increased subsidies — you can now get a silver plan as opposed to a bronze plan, which lowers your deductible [and] your copayments?”
Figuring out the right plan for you doesn’t have to require a huge time commitment, he says. His team aims to get people in and out — enrolled in a plan — in an hour and a half. And those appointments don’t have to be in person — customers can get help by phone and can often do everything they need to do to get signed up virtually.
Though signing up for health insurance can be confusing at first, it’s also very important — for your wallet and your health. Hang in there — and know there are people out there eager to help you make sure you get covered.