Tips on How to Get the Most Out of Obamacare

Health Insurance

October 31, 2015

Comparing Plans is Essential

Whether you have already enrolled in the ACA’s online exchange, have never signed up for open enrollment, or need to shop for coverage because you no longer have employer supplied coverage, it is during the in-between open enrollment period that you should be comparing plans to make sure you will be getting the biggest bang for your healthcare dollar.

If you’re already enrolled please remember the plan you have now may (likely) be changing next year and might not still be the most affordable or best possible coverage available to you, you need to compare plans, shop around. The health insurance marketplace is continually changing to meet the demands of consumers, as well as addressing ACA implementation issues, it is important to always review and compare your health insurance coverage and costs as change is certain to occur each year.

Help is Here to Get You the Most Affordable Best Possible Plan

If you are just getting ready to get coverage for the first time, either through the ACA’s federal exchange or your states own exchange, comparing plans and rates is crucial to getting the best coverage for you or your family. Getting started may seem a difficult or confusing task, but that is exactly why we are here providing qualified assistance resources that are available to help you sort through any questions you may have and help you navigate through the enrollment process. The assistance goals are to aid new insurance consumers with enrollment, helping you to understand the healthcare law’s requirements, and assisting consumers to learn about insurance plan options, coverage and help determine if you qualify for subsidies to help you pay for your insurance plan.

Below are the key points of comparison you should be certain to examine when choosing a plan:

  • Understand your healthcare needs there are different types of healthcare insurance plans, your particular healthcare needs will determine what type of coverage will be most beneficial to you. Examine your actual healthcare spending, lower cost monthly premium plans (bronze tier) often have high out-of-pocket expenses such as high deductibles and high prescription drug costs. Also if you know you are facing a surgery in the near future you may want to opt for a higher premium policy (gold tier) with low deductibles and fewer out-of-pocket expenses for that year and later switch back to a plan that meets your ordinary healthcare needs. Being aware of your needs and options is important to getting the most out of your healthcare dollars.
  • Make certain (call to check) your primary care physician accepts the specific plan (and tier level) you are considering to purchase, as well as any specialist physicians that are treating you for any existing health conditions you need regular scheduled treatment for. For example, if you are a diabetic you likely are under the care of an endocrinologist who specializes in treating diabetes and diseases of the endocrine system and an ophthalmologist as diabetics must carefully monitor their vision care.
  • Do not rely on the list of providers from the insurance company as participating doctors frequently change. Directly contact the doctors on the providers list yourself that you will need to see to be certain they are still included in the network of providers and are accepting new patients.
  • Medications and prescription drug coverage are a very important part of choosing an insurance plan; unfortunately it is one of the more fluid (changes frequently) areas of insurance coverage, and the plans may differ in the ways in which you are covered. For example, again using diabetics to illustrate the point, a diabetic may be taking a specific brand name oral medication to treat their diabetes, it is important to find out if the prescription drugs you are taking are covered by the plan you’re considering.
  • Prescription plans coverage varies too, some plans may pay a certain percentage of the cost of the drug, others may have a fixed cost per drug based on whether the drug is categorized as “preferred,” “non-preferred,” or as a “specialty” drug, generic, non-generic (brand name) etc. there are numerous variables.
  • Covered drugs change frequently. It is important to note that a specific drug may be covered on your plan today, but may be dropped by your plan later. Usually when the plan drops a specific drug it replaces it with another comparable drug, but not always. The best practice for making certain your medications are covered is to ask the insurance plan (company) you are considering to provide you with a link to their “formularies” which will give you a list of all the drugs covered in the plan, how much of the cost you are required to pay for each drug and the strength of the drug. The strength of the drug is important because some or one strength of a drug may be covered, while another strength of the same drug may not be covered at all. Create a list of all the medications you take, how often you take it each day, and the dosage strength and check the insurance company’s formularies carefully!!
  • Know your hospital coverage; this can be another area where you can get an unpleasant surprise when you need to utilize your insurance. Make sure you completely understand what your policy does and does not cover and any requirements of you the policy may require.
  • Emergency Department (ED) visits often have certain requirements of the insurance policy holder to fulfill, to avoid high out-of-pocket expenses, make certain you fully understand the coverage provided and what your responsibilities are.
  • Make sure you carefully read all mail coming from your insurer, each year it will contain a letter describing any changes in your plan. Carefully consider any changes to your plan that affect you. This is also a good time to again compare plans, get new quotes each year to be certain you are getting the best price and coverage for your area.
  • Keeping your financial (income) information current is important because if there were any life changes that occur such as an increase or decrease in your annual income, divorce, marriage, birth of a child, death in your family any of these life changes could change your eligibility for subsidies to help pay for your insurance premiums. You should update your information with your state exchange website even if you aren’t going to change your insurance plan and had no life changes because the subsidy amounts are likely to change from year to year, keeping your income info updated can prevent you from getting any surprises when filing your tax returns.

Finding the best healthcare plan for you and your family simply requires a bit of time and attention to detail, there are many forms of assistance and tools available to help you make an informed decision. Don’t hesitate get the coverage the ACA requires today.