The open-enrollment period for health insurance plans comes only once a year and the associated paperwork usually generates as much joy as a mid-July heat wave. But don’t be tempted to check the box next to your current health plan just to avoid a little extra reading. Once you’ve made your decision, you’re stuck with it for a whole year. This easy, four-step guide will help you break down the confusion and reveal the plan that’s best for you.
SECRET #1: Cheaper Health Plans Don’t Always Cost You Less
Shopping for health insurance can be like buying a pre-owned vehicle — you might think you’re getting a good deal when you drive away from the dealership, but there could be additional costs you didn’t expect right around the corner. Many health plans have hidden variable costs that can include premiums, co-pays, deductibles, exclusions and more. For example, you might select a plan with $15 co-pays for general office visits and $60 co-pays for specialists. That’s pretty reasonable if you only see your general practice provider during the year, but doctors, such as chiropractors, dermatologists, physical rehabilitation specialists, pain management physicians and more, may be considered specialists even if you see them on a regular basis.
Prescriptions are also a huge factor when finding your insurance match. Even if you don’t go to the doctor every month, chances are, there are one or more monthly prescriptions you depend on. Some plans use a tier system for prescriptions, which may end up hitting your wallet more than you expected. For example, your insurance plan may boast having hundreds of prescriptions under $10, but the pain medication you need after surgery or your monthly blood pressure pills may not fit under that category. You could also find that some of the prescriptions you need may not be covered by your plan at all.
It’s important to compare the value of your benefits versus your annual cost. Don’t be afraid to ask your insurance company about costs for the benefits you need. Think of it this way: if you go with a cheaper health plan but it doesn’t pay for the doctors and prescriptions you need, you’re not really making the most out of your health insurance dollars.
SECRET #2: Some Benefits are Just an Illusion
Shopping for insurance might sound only a touch more appealing than getting a root canal (which may or may not be covered with your current plan), but it’s a chore that could guarantee your benefits match up with the services you need. You may not be the only one who’s made modifications within the last year— insurance companies can change benefits and coverage options sometimes faster than you can say, “HMO,” so it’s important that you read the fine print to see where your existing plan may have changed.
Did your insurance company alter benefits, add new plans or remove coverage in certain areas? Look for adjustments like an increase in cost for your spouse or dependents or the plan dropping coverage for your monthly prescription. It’s also important to be on the lookout for illusionary benefits (AKA “perks” that don’t provide value to your coverage). For example, some plans claim to have chiropractic benefits but then only allow $43 per visit and have a co-pay of $40. Other companies sell out-of-network benefits but then penalize your doctors if you use them. Being aware of these small changes could make a big impact on your quality of care in the future.
SECRET #3: Your Favorite Healthcare Providers Aren’t Included with Every Plan
Pretend you’ve been invited to a V.I.P. event with your best friend. When you arrive, the bouncers wave you through to the red carpet but keep your companion locked up behind the velvet rope. The abrupt separation could cause confusion, distress and anxiety for both of you and it would most certainly ruin your experience.
The same uneasy feelings can occur if the insurance plan you choose doesn’t include your favorite doctors on their exclusive “preferred provider list.” It’s no secret that your doctors play major supporting roles when it comes to your wellness and the key to staying healthy is visiting them for routine maintenance or when you don’t feel well. But let’s be honest: if you’re forced to visit a clinic you loathe, your chances of actually going are less likely than a D-list actor winning an Academy Award.
The best way to keep your favorite clinic and physicians is to do some minor research before committing to a plan. Check insurance company websites to see whether your primary care provider and any specialists you favor are included in the plan’s network. (We like the easy-to-use Find A Doctor Directory on Blue Cross Blue Shield of Arizona’s website.) While you’re searching, keep in mind that some companies have abundant lists of health care providers, but many are no longer accepting new patients or won’t be able to get you in for weeks.
SECRET #4: Experience is Everything
If you’re planning a vacation to Disneyland, you probably think about how to create a trip that’s enjoyable, cost-effective and includes everything you want to do. If you go with people you enjoy spending time with, such as friends and family, you’ll have a lot of fun and end up with some great memories. And if you plan to go on a weekend that’s less crowded, you’ll spend less time in line, experience more rides and have the satisfaction of getting good value for the money you spent.
If you think about it, the same theory applies to choosing health insurance. If you want your overall health care experience to be enjoyable, cost-effective and inclusive of everything you need, such as medical services and prescriptions, you’ll need to choose a health plan that incorporates all of those things.
For example, if you see several types of doctors such as a family physician, a chiropractor and a pain management doctor, consider choosing an insurance plan that allows you to visit an office that provides multiple specialties in one location—this could save your bank account from a day or two of childcare or spending vacation days to see your doctors across multiple days. The plan you choose could be inexpensive, the services you need may be covered and your doctors may be contracted, but are you really saving time and money if you have to drive to multiple locations to get what you need (one location for appointments, another for labs, a third for x-ray, etc.)?