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Tuesday, October 22, 2013
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How to Optimize Your Health Insurance Plan
Q: Its open enrollment season for health insurance. What should I compare policies on to make sure I get the best one for the price?
A: Generally, you want to look at price, coverage, and ease of use. Clearly, affordability should weigh heavily in your decision, but don't let that be the sole criteria. "Costs are much more than premiums," says Leslie Fried, director of the National Center for Benefits Outreach and Enrollment and director of policy and programs for the National Council on Aging.
If you have a preferred doctor, make sure he or she accepts the plan you're considering, says Frederic Riccardi, director of Client Services at the Medicare Rights Center. Also, look at the prescription drug costs in the plan and whether the drugs you take are actually covered, the deductible you have to pay before benefits kick in, and the overall amount you can be expected to shell out in any given year.
If youre in good health and single, you can save money by picking a low-cost, high-deductible plan that will cover you mainly for major procedures. However, if you go to the doctor a lot or have kids, dont make the mistake of picking a cheap policy only to later discover that it only covers major injuries or catastrophic illnesses. In the new Insurance Marketplace, established as part of the Affordable Care Act, the Platinum Plan offers the highest premium with the highest coverage. The Bronze Plan offers the lowest premium but also the least amount of coverage, with the individual paying 40% of medical services, says Fried.
On the coverage front, find out what services and procedures are included—as well as which treatments are excluded. Then, figure out how you would fare in a typical year, based on your expected use of benefits, the premiums, co-pays, and prescription drugs you may need. For instance, if you take specific medications, you might choose a plan with higher premiums if the drug costs were low enough to offset it.
Finally, check how easy it is for you to access benefits: How do you submit claims? Is phone or online assistance readily available? And whats the process for seeing specialists or consulting doctors of your choice? Weigh all three of these areas—cost, coverage, and ease of use—on what your likely medical needs will be for the upcoming year, then go with the plan that has the best fit.
And open enrollment happens every year, it's important to review your coverage every year. "If your health status changes, you're going to want to revisit your choices," says Fried.
How Much Will My Health Insurance Cost?
Finding health insurance that doesn't crush your household budget may soon get a little easier thanks to the new health insurance marketplaces, or exchanges, operating in every state.
But how much will a good health plan set you back? And do you qualify for a federal tax credit to lower your monthly premiums?
You can find out what your costs and potential savings might be when you submit an application for health insurance through your state marketplace. (Open enrollment in the health insurance exchanges, a centerpiece of the health reform law known as the Patient Protection and Affordable Care Act, runs from October 1 through March 31, 2014.)
But if you just want a rough estimate before diving into the exchange, you can try one of the online calculators that have popped up on the web, including some state marketplace websites.
“I think its a first good place to get started,” said Regan Hunt, executive director of Kentucky Voices for Health, a Louisville-based nonprofit coalition working to ensure access to affordable health care. “Some people really like to do their due diligence and their research before getting online to go shopping,” she said.
However, the calculators are limited in what they can tell you, she added. How you define your household size, for example, or your estimated earnings after a job loss could affect the numbers.
“Your final premiums and costs may differ from the estimates, perhaps significantly, depending on where you live and the coverage you select,” cautions HealthCare.gov, the federal governments website for health reform information.
Hunts advice? Try several calculators to see if theres much difference in the answers you get. “Dont just stick with one.”
Four Calculators to Try
The Henry J. Kaiser Family Foundations Subsidy Calculator
HealthCare.gov directs consumers to The Henry J. Kaiser Family Foundations subsidy calculator . Enter your state, an estimate of your 2014 annual income, whether you have access to employer coverage, the number of people in your family, including the number of adults and children, and whether anyone is a smoker.
The calculator can tell where your household income ranks as a percentage of the federal poverty level, whether you would qualify for Medicaid and, if you qualify for coverage through the marketplace, what your annual premium might be and the size of the federal tax credit you may receive to offset your costs. Itll tell you the premium and cost-sharing amounts for a “silver” plan and compare those estimates to what you might pay in a “bronze” plan. It also tells you the most you would pay out of pocket.
If you have kids, the calculator will advise you about other coverage options, such as the Childrens Health Insurance Program.
eHealth Inc.
At eHealth Inc. , the parent company of online health insurance site eHealthInsurance, you can find out whether you may be eligible for the premium tax credit based on your household size and income level.
Just plug in a few pieces of data and the calculator spits out the amount of the tax credit you may receive based on a typical plan in your state. It also tells you the penalty you would pay in 2014 if you chose not to remain uninsured.
GoHealth
Or you can try GoHealth , another online portal for health insurance, which calculates your premium and tax credit using your zip code, income, age and family size.
SHOUTAmerica
The nonprofit group SHOUTAmerica, through its educational initiative Young Americans for Affordable Healthcare offers a tool for figuring out how health reform will affect young adults insurance costs in 2014.
Use it to ballpark your cost after any applicable premium tax credit. You can also learn about other health insurance options. For example, young adults under 26 may be eligible to stay on their parents health plan, and adults under 30 can buy a “catastrophic” health plan with a lower premium but higher out-of-pocket costs.
But how much will a good health plan set you back? And do you qualify for a federal tax credit to lower your monthly premiums?
You can find out what your costs and potential savings might be when you submit an application for health insurance through your state marketplace. (Open enrollment in the health insurance exchanges, a centerpiece of the health reform law known as the Patient Protection and Affordable Care Act, runs from October 1 through March 31, 2014.)
But if you just want a rough estimate before diving into the exchange, you can try one of the online calculators that have popped up on the web, including some state marketplace websites.
“I think its a first good place to get started,” said Regan Hunt, executive director of Kentucky Voices for Health, a Louisville-based nonprofit coalition working to ensure access to affordable health care. “Some people really like to do their due diligence and their research before getting online to go shopping,” she said.
However, the calculators are limited in what they can tell you, she added. How you define your household size, for example, or your estimated earnings after a job loss could affect the numbers.
“Your final premiums and costs may differ from the estimates, perhaps significantly, depending on where you live and the coverage you select,” cautions HealthCare.gov, the federal governments website for health reform information.
Hunts advice? Try several calculators to see if theres much difference in the answers you get. “Dont just stick with one.”
Four Calculators to Try
The Henry J. Kaiser Family Foundations Subsidy Calculator
HealthCare.gov directs consumers to The Henry J. Kaiser Family Foundations subsidy calculator . Enter your state, an estimate of your 2014 annual income, whether you have access to employer coverage, the number of people in your family, including the number of adults and children, and whether anyone is a smoker.
The calculator can tell where your household income ranks as a percentage of the federal poverty level, whether you would qualify for Medicaid and, if you qualify for coverage through the marketplace, what your annual premium might be and the size of the federal tax credit you may receive to offset your costs. Itll tell you the premium and cost-sharing amounts for a “silver” plan and compare those estimates to what you might pay in a “bronze” plan. It also tells you the most you would pay out of pocket.
If you have kids, the calculator will advise you about other coverage options, such as the Childrens Health Insurance Program.
eHealth Inc.
At eHealth Inc. , the parent company of online health insurance site eHealthInsurance, you can find out whether you may be eligible for the premium tax credit based on your household size and income level.
Just plug in a few pieces of data and the calculator spits out the amount of the tax credit you may receive based on a typical plan in your state. It also tells you the penalty you would pay in 2014 if you chose not to remain uninsured.
GoHealth
Or you can try GoHealth , another online portal for health insurance, which calculates your premium and tax credit using your zip code, income, age and family size.
SHOUTAmerica
The nonprofit group SHOUTAmerica, through its educational initiative Young Americans for Affordable Healthcare offers a tool for figuring out how health reform will affect young adults insurance costs in 2014.
Use it to ballpark your cost after any applicable premium tax credit. You can also learn about other health insurance options. For example, young adults under 26 may be eligible to stay on their parents health plan, and adults under 30 can buy a “catastrophic” health plan with a lower premium but higher out-of-pocket costs.
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