When open enrollment season for insurance arrives, you’ll face a wider range of choices than ever before — especially with a second round of enrollment for the Affordable Care Act’s health insurance exchanges starting in November.
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Heed this expert advice: Do your homework.
When shopping for a plan, start with the basics of what you’re looking for and what you’re willing to pay for, says Michael McMillan, Executive Director of Market and Network Services at Cleveland Clinic. Then make your selection carefully so you get what you’re paying for, he adds.
To help you navigate enrollment — either on health insurance exchanges or elsewhere — McMillan offers the following helpful tips:
1. Know what services are covered under a selected plan
Start by reviewing what each particular plan offers. For example, what does the network of care providers look like? What services are most important to you based on your particular health needs or conditions, and are they available within a plan’s coverage?
“This will be a period of great change, and consumers will have a lot of options they haven’t had before on the exchanges,” McMillan says. “It’s important to be clear on what’s available and what isn’t.”
2. Make sure your providers are part of the network
When choosing plans, this is a major factor. Look at any given plan to see if your doctors and hospitals you use regularly are listed as network providers.
One evolving trend has been for health plans to create narrow networks — smaller versions of their standard network that help them achieve a lower price. The bottom line: Not all providers are included in these limited networks, so it’s worth your effort to check first and make sure your new plan includes the doctors and other practitioners you see regularly, McMillan says.
“Look at any given plan to see if your doctors and hospitals you use regularly are listed as network providers.”
3. Know your out-of-pocket costs
These are costs associated with the care received. They include things such as deductibles — the amount you pay before coverage kicks in — as well as copays and coinsurance on services. Out-of-pocket costs vary by the “metal” level of plan you choose on a health insurance exchange. So, for example, you would pay 40 percent of costs of coinsurance in a bronze plan, and 30 percent for silver.
In some high-deductible health plans, the first several thousand dollars will be your responsibility, too. For your personal budgeting and planning, it’s critical to know how much money you’ll have to pull out of your pocket when you go to the doctor, to the hospital, to the medical lab or for any other health service, McMillan notes.
4. Understand how your monthly premium works
Premiums are the monthly payments you make for your insurance coverage. Because the benefits for most plans, both on and off the exchanges, have become standardized, it should be fairly easy to make apples-to-apples comparisons among plans.
“You should be able to compare premium amounts, how much you pay every month for the service,” McMillan advises. However, your personal premiums may vary depending on your own circumstances — including whether you’re single or married, a smoker or a nonsmoker, and other factors.
Open enrollment periods for insurance plans outside of exchanges vary. No matter which path you pursue, learn as much as possible about your plan options before you buy, and you’ll end up with coverage that suits your needs as a result.