Trees painting the outdoors with their leaves, chillier
nights, shorter days—you know what that means.
It’s Medicare open enrollment season.
Okay, maybe that’s not what came to your mind first. But working as I do (at least tangentially)
with the Medicare program, I know October 15 to December 7 to be the annual
opportunity for the Medicare-eligible population to choose their coverage for
next calendar year. But it’s also the
time of year in which many employers have their own open enrollment for workers
to select their health care plan or other benefits for the next twelve
months. And this week many Americans
began shopping on the various insurance exchanges for their 2018 health
insurance under the Affordable Care Act (ACA).
If you fit into any one of those categories, here are a few
tips to making your selection.
Cost is about more
than the monthly premium. An
insurance policy with lower premiums may not be a bargain. Your co-pay (the
amount you have to pay at each health care encounter), your co-insurance (the
percentage of the cost of a service that you are responsible for paying), and
your deductible (the dollar amount of your expenses you are responsible for paying
before your insurance even kicks in its first dollar of coverage) could all be
much higher and more than erase whatever you save in monthly premiums.
The deductible can be the real killer. When I’ve called on doctors’ offices as part
of my job, their main complaint about the ACA has been some of the plans’ high
deductibles. Patients come into their
office, excited to finally have health insurance, only to learn it covers $0 of
the first $5000, or even $10,000, of medical expenses. Essentially, they just have catastrophic
health insurance. To avoid that trap, read
the policy description thoroughly and try doing a little math based on the
number and cost of your (and your family’s) doctor, urgent care, lab,
radiology, and hospital encounters over the past year. Will you likely meet the deductible early in
the year? Not at all? If you or a member of your family suffer from
a chronic condition or are otherwise a frequent user of physician or hospital
services, then paying a higher premium to ensure the insurance company starts
paying for services earlier might well be worth it. Take note of the out-of-pocket limit, the
maximum amount you would be responsible for paying before the insurance company
begins paying at 100%.
Are your providers “in
network” with the insurer? Many
health insurance plans have a limited universe of providers who are considered
in their network. It is important that
you determine if your preferred doctors—both primary care and specialists—as
well as the local hospital and pharmacy and the nearest full-service large
medical center are considered “in network” with the plan you are contemplating
buying. Using in-network providers keeps your costs lower.
The insurer’s website is usually the best source for determining
who is in their network. Be certain you select the correct plan on the website,
because they are likely to have several plans, each with its own network of
doctors.
But I’ve found that those online listings can be out-of-date. I recommend you also call your doctors’
offices and speak with either the insurance clerk or the
office manager to double-check. Let me
stress that when you call that you do NOT say, “Do you accept XYZ Insurance?” You SHOULD directly ask, “Are you in XYZ’s
network of approved providers?” The
difference can be critical. A provider
may “accept” any insurance, in the sense that they will file a claim to any
company. But if they are not in-network
then they will be paid less, and you will be responsible for more of the bill,
if not all of it.
Investigate the
reputation of the insurance company.
This can be easier than it sounds.
If you are shopping for a Medicare Advantage plan (also known as a Part
C plan), the government rates them on a star system: one star for poor customer service, up to
five stars for superior service. For
other insurances, there is not an equivalent rating system; but friends or even
co-workers can make recommendations based on their experiences. And again, your physician’s office can be good
source of intelligence. I have found
that the back-office staff freely discusses what insurance companies are better
than others, which ones are reliable payers, and which they like more than
others. You might be surprised to learn
that insurance companies that advertise the most and are best known by the
public do not enjoy a good reputation among the providers I know. Just
remember, a physician’s contracts with the insurance companies most likely
restrict him and his staff from recommending one company over another, so don’t
ask them to tell you which to choose.
Happy Open Enrollment.
And until next time,
Roger
And perhaps the best way to save money on health care in
2018:
“Dear friend, I pray
that you may enjoy good health and that all may go well with you, even as your
soul is getting along well.” III John 2 NIV®*
*Scripture quotations taken from the Holy Bible, New
International Version® NIV®
Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™
Used by permission.
All rights reserved worldwide.
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