Shopping for health insurance?
To make sense of what works for you, you’ll need to understand how your own medical spending patterns interact with the details of the different plans for which you qualify.
1. Understand your options.
If you’ve recently left your job or been laid off, COBRA is the simplest option. It allows you to stay on your employer’s plan. But because it requires you to pay the full cost, it may not be the least expensive. That’s because many employers subsidize the premiums for employees who never see the full bill. If you’re healthy and see the doctor rarely, you may be able to find a high-deductible plan with less coverage at a lower cost.
On the other hand, if you have medical issues, COBRA may be a better deal overall. “The central issue of COBRA, which is critical for people to examine if they or their family have a pre-existing condition, is that you don’t have to worry about qualifying for it.
When you are looking for health insurance, the variables are what do you need, what does it cost and how does it compare with other options. Paying for the richer coverage if you are in a situation where you are not going to use it is throwing money down the fireplace. One option worth looking into for those who are between jobs is the discounted state-run programs.
2. Shop around.
Insurance is complicated and the cost savings from finding the right plan can be dramatic, so you’ll want to shop around and understand what you’re buying. You simply plug in your information and get quotes, the way that you would for auto insurance or a credit card.
Another way to shop around is to hire an insurance broker who can lead you through the maze. Not all brokers are equally good, to say the least. It’s best to get a referral from a trusted friend or family member. Either way, you’ll want to get multiple quotes and you’ll want to compare the plan details as well as the top-line monthly premium costs.
3. Consider affiliating with a group.
Group insurance is typically cheaper than getting it yourself. When you’re on staff, your employer automatically gets group rates. When you’re on your own, one way to go is to find or create a group. Trade groups, alumni associations and other organization may offer association plans, which allow you to be in the group for insurance purposes.
4. Don’t forget that health insurance is tax deductible.
When you’re self-employed, you can deduct your insurance premiums for tax purposes. They’re taken as a so-called “above-the-line deduction, meaning they’ll reduce your adjusted gross income regardless of whether you itemize.
Medical expenses, on the other hand, are a Schedule A deduction, meaning you can only take them if you itemize and you can only deduct them after they exceed 7.5% of your adjusted gross income. The upshot is that the net cost to you of a dollar spent on health insurance will generally be less than the net cost of a dollar spent on medical care.
5. Cost out different plans.
It’s not necessarily the case that the cheaper health insurance will prove less expensive in the long run. It depends on what your health spending runs, what the details are about your in-network vs. out-of-network usage, what’s excluded from the coverage and a host of other factors. Before you start shopping, try to understand your family’s medical spending and patterns, what doctors do you see? What medical services have you used in the past few years? Do you travel often, meaning you may be outside the coverage area for a particular plan just when you need it?
Once you understand your health issues, then you can move on to the financial ones. Premiums are important, but the other fees you’ll face (such as the co-insurance for doctor visits or the cost of going out-of-network to your longstanding doctor) are equally important. Watch especially for benefit limits and exclusions. Understanding your own health spending patterns will help you know whether it’s better for you in the long term to pay a cheaper amount per month for a plan with a higher deductible vs. paying more in premiums for a plan with a lower deductible.
What Health Insurers Don’t Want You to Know
You need to make sure that you are always on the same page as your health insurance provider. The both of you need to come to a conclusion that works out. This does not mean that the health insurance company is going to be completely honest with you. There are some things that they do not want you to know because that could give you an advantage over them.
As the buyer you should always be looking for an advantage over the health insurance company. Take your time and read through some of these tips, because they aim to help you do the best that you can with your health insurance.
Challenge the Fine Print
This is the first thing that health insurance providers do not want you to know. When you are discussing a plan with them they will go over all of the details with you before you sign on. This will seem like they are describing everything for you in great detail. Unfortunately there is still fine print that you need to read. This is something that should be reading while you are still talking to the health insurance provider. Most insurance companies want you to wait to read the fine print until you have signed up, but by then it might be too late. Read early and challenge often.
What States Says Insurance is Require to Cover
Every state will have a mandate of the things that health insurance must cover. Certain treatments will be covered and certain things need to be provided. This is something that you need to check on before you go to get health insurance. You also need to keep the provider in line and make sure these things are provided. Sometime health providers will try to sidestep things that need to be done because it will save them money. This is why they might not tell you about this. It is your job to make sure that you are following the state laws and getting what is required. It is up to you to keep them in line.
How You Can Appeal
No decision is final. If you get denied a claim on your health insurance then you should not just sit there and take it. You can appeal the decision and see if you can get the ruling overcharged. This is not something that the health insurance provider wants to be up front about because it could cost them more money. This is why you need to ask them about the appeal process and how you can partake in it. They probably will not tell you until you really need it, so make sure you get a head start on them and find out about it right away. You never know when you might have to appeal and you need to be prepared.