The window for switching or signing up for an insurance plan is quickly coming to a close for 2017. Unless you experience a qualifying life event that lets you sign up for health insurance outside of open enrollment, your last opportunity to make any changes is the January 31. Whether you’re content with your current level of coverage or you need to make some adjustments, looking into your choices is never a bad idea. There are plenty of reasons you might consider changing to a new plan, including new medical problems, different prescription drugs or the level of care that you’re currently getting under your providers. Here are a few good reasons to take another look at your plan for this year.
Coverage
Does the plan you have cover your medical needs? This is the single most important question to ask yourself because if your plan doesn’t cover the services that you need, then it’s not a good plan for you. Review the providers, services, treatment options and other features of your plan to make sure that they fall in line with what you need. People with certain medical conditions, like cancer or diabetes, need greater care, and your coverage should grant you access to a selection of providers who specialize in those conditions. Make sure that your health insurance for 2017 covers what you need, and find a new plan if it doesn’t stack up.
Cost
For most consumers, cost is the number one feature affecting health insurance plan selection. But don’t let the base numbers fool you. The less you pay per month, the higher your out-of-pocket costs will be. The goal is to strike a balance between your monthly premium and the cash you’ll have to pay from your own wallet. Review your plan this year to see if it’s financially sound. How much did you spend last year, and how much do you expect to spend this year? People with kids may need more comprehensive coverage to offset the likelihood of accidents and illnesses. There are other considerations when crunching the numbers, including:
- How much you have to pay for in-network services vs. out-of-network providers. Some plans allow you to see anyone you want (for an extra cost), while others won’t cover anything out of network.
- Your prescription drug copays and limits. Are you paying for the drugs you need?
- Your deductible and out-of-pocket limit. In 2017, plans purchased on the exchanges have an out-of-pocket spending cap of $7,150 for individuals and $14,300 for families. That’s the most you’ll have to pay out of pocket before your plan covers all services at 100 percent. But for most people, these limits are high. Check your plan’s out-of-pocket limit and deductible to make sure you can cover these costs if you need to.
It’s not always easy to calculate what you’ll really be paying with a given health plan, which is why you should consult with a health insurance adviser about your options. You may be eligible for discounts, cost-saving tax credits or other assistance to bring down your premiums and help you cover the cost of care. For people who don’t have benefits through work – and therefore don’t have access to someone who can explain the costs – speaking with an agent is the best way to make sure you understand the real figures behind those advertised rates.
Prescription Drugs
Not everyone needs comprehensive prescription drug coverage, but it’s considered an essential service under the Affordable Care Act, which means that all major medical plans on and off the exchanges that were created after March 23, 2010 have to cover them. Still, some plans cover prescriptions at different tiers and at different costs. If you need certain drugs, make sure your health plan covers those drugs. Brand name prescriptions and generic drugs often work the same, but some brand name products do work differently. For people who need the real thing, having a health plan that covers brand names is essential. Talk to your doctor about your drug needs for the year, and switch to a new plan if you need more robust drug coverage.
Quality
Believe it or not, health insurance companies get rated just like anything else, and those ratings can make a difference in your long-term care, treatment and overall satisfaction. If you’re not happy with your current company, check its rating and reviews to see if others are having similar problems. It’s important to buy from companies you trust, so ditch your current insurer if it isn’t working for you. Consider the following:
- Customer service: Can you speak with a live agent when you need to?
- Ease of use: Do you have to do all the paperwork yourself, or is someone available to assist you? How long do claims take to process?
- Clarity: Does the company offer a clear outline of your coverage and benefits, and is there an online resource that you can use to check the status of your claims, ask questions or find out more information?
Ask friends and family for recommendations, but don’t forget to ask your providers for their advice as well. They may have better insight into a company’s innerworkings, which can help you make a decision about who to use.
Convenience
In a perfect world, we would all have health insurance that transcends time and works on our schedule, wherever and whenever we are. But that’s not the norm, and you will have to sacrifice some convenience when you buy a health plan. Still, some insurers and some plans are more convenient than others. Depending on type and level of coverage, you could be restricted to a set of specific providers without the option to go outside the network. For those who travel, coverage outside the country may also be an issue. And in an emergency, you don’t want to have to think about if your plan covers the closest medical facility. Check the terms of your coverage to see if it can keep up with your lifestyle. If it can’t, find a plan that will.
Enroll Today
The window for changing your current health plan is short. You have until January 31 to make any changes to your plan for 2017 unless you qualify for a special enrollment period. Take the next few days to review your policy in detail and ask the questions that you need to make a good decision. Outside of open enrollment, you can only sign up for major medical coverage through your work (if you get a new job that offers coverage), so now’s the time to enroll.
