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(HealthNewsDigest.com) – Open enrollment began November 1st – are you ready to shop for and purchase health insurance? The number of plans offered is overwhelming, and the challenge comes in knowing what to look for when finding a plan that is right for you. The 5 main factors to consider in your health plan selection are the premium, the level of benefits, out-of-pocket costs, your network of doctors, and value added benefits.
The premium is the amount per month that you have to pay for getting coverage. Last year in New York, for example, this cost averaged $369 for a Silver plan. Silver represents the “metal level” of a health plan, which includes Bronze, Silver, Gold and Platinum. The premium differs by metal level, meaning that Bronze plans will have the lowest premiums and Platinum plans will have the highest. The higher premium plans will pay for more of your medial services and drug costs when you receive services versus those with a low premium.
You typically have to pay out-of-pocket costs when you use medical services, like a doctor’s appointment or a hospital admission. Each health plan has a maximum out-of-pocket limit that indicates the most you will have to spend to cover services during the year. Your maximum out-of-pocket limit includes: copays – the flat fee you pay in order to receive medical service; coinsurance – what you pay in order to receive medical services as a percentage of its total cost; and the deductible – the amount you contribute before your insurance starts paying for your services. Remember, preventive care visits like annual checks-ups are covered at no charge!
An additional factor to consider when selecting a health plan is the network of doctors and hospitals you and/or your family will have access to. If you have an ongoing relationship with a doctor or a hospital, it’s important to find out whether or not they will be a part of your new plan. Many health plans require that you pay for all or most of the cost of services if you visit a doctor or hospital that is “out-of-network.” To avoid this, always check with the doctor or hospital directly to make sure they are in-network with your insurance plan before you receive services.
Lastly, don’t forget that each plan may come with value added benefits. While all health plans cover the essential benefits (hospital stays, prescription drugs and access to mental health specialists, etc.), some health plans also provide options like video-enabled access to doctors, wellness programs to help you stay fit, and other services that are designed to support and encourage a healthy lifestyle.
Although having a lot of choices in plans may seem daunting, it is important to enroll in coverage before the end of Open Enrollment on December 15th. The financial cost of not being covered in 2017 comes in the form of a tax penalty. This penalty is substantial; it can cost 2.5% of your household income or $695 per person, whichever is the larger amount for your situation.
By understanding your premium, the level of benefits, out-of-pocket costs, your network of doctors, and value added benefits, you will be prepared to shop smart for a plan that fits your needs and your budget while avoiding the risks of remaining uninsured. Happy shopping!
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