Your Health Plan Needs a Checkup

Health Insurance

June 25, 2020

As we head into July, health insurance might be the last thing on your mind — if it even makes the list. With four months to go until open enrollment for marketplace coverage and half a year left with your current plan, you probably haven’t given that insurance you bought last fall much thought.

That is, unless you hate it.

Or you need new coverage because you got married, had a baby, lost your job or moved.

We’ve covered special enrollment periods for major medical plans before. You can check out tips on getting full coverage outside of open enrollment here and here.

What we’re talking about today is a little different. 

It’s about taking a mid-year moment to think about your health insurance needs and whether they’re being met with what you’ve already got. If so, great!

But if not, it’s time to start thinking about what you really want from a health plan.

Why think about it now?

Assuming you don’t get health insurance from your job or a government program, like Medicaid, you have one chance to buy major medical coverage each year. It’s called open enrollment. And it runs from November 1st through December 15th in most states. (Some states have longer enrollments.)

During open enrollment, you can shop around, find a new plan, and buy something that works better or costs less. It’s a 6-week period where you can compare your options and pick one that fits. 

Six weeks might seem like a long time. But when it comes to picking a health plan, it’s not much. 

Plus, open enrollment happens right in the middle of the holiday season. While you’re trying to perfect the recipe for your great aunt’s famous stuffing and shop for your hard-to-please grandpa, you’ll likely put your health insurance needs on the back burner.

So, why think about health insurance when you can’t do anything about it until November? 

Because right now, you’ve got time.

Holiday-free time, we might add. 

And this summer, you might even have more time than usual thanks to the pandemic that’s keeping everyone home more often. 

Right now gives you the perfect opportunity to take a good, hard look at your existing health insurance and learn more about it. Find out what it covers. See if it’s as great a deal as you thought it was when you bought it.

Perhaps you bought a plan on a whim last December because open enrollment snuck up on you? It happens.

But you don’t have to wait until November 1st to start planning. Like buying Christmas gifts in July, thinking about health insurance is a task that benefits from proactive attention.

Translation? Start early. Start now.

Signs your health plan isn’t working

Now that we’ve convinced you to start prepping for open enrollment now, you might wonder how you even begin such a task. After all, health plans are more or less the same, right?

Nope. Not even close.

Sure, all major medical plans cover 10 essential health benefits and provide a truckload of consumer protections thanks to the Affordable Care Act. But beyond the basic structure and regulations, major medical plans vary widely.

Cost, coverage, benefits and perks all differ. 

Not all companies are the same, either. They might all seem similar. But insurers also vary in terms of customer service, claim payouts, how easy they are to work with and other factors. And what works for you as a consumer might not work for someone else, like your best friend. 

Here are some signs that your current health plan isn’t working for you:
  • Your premiums are too high. “High premiums” is a relative phrase in the insurance world. But if your health insurance premiums — not to mention coinsurance rates and copayments — are so high that they eat a big chunk of your monthly budget, something’s amiss.
  • Talking is an uphill battle. Claims denied without explanation? Can’t get through to a real human, let alone one who can help you? Customer service matters in a health plan. If your company isn’t helping you, it’s time to find one that will.
  • The fine print was even finer than you thought. Plan contracts can be tough to wade through even for pros. If you consistently find that your coverage isn’t what you thought it was, you need a new plan — one that will actually cover your needs.
  • Your needs have changed. And speaking of needs, a lot can happen in a year. Special enrollment periods let you change coverage for things like getting married or adopting a child. But what happens if you get a new medical diagnosis and need more coverage? Your health plan should keep up with your health needs.
  • You’re afraid to use it. Probably the biggest red flag there is. If you avoid trips to the doctor because you’re afraid of the cost — even though you have health insurance — then you don’t have the right health plan. Insurance can be pricey. But it shouldn’t be so pricey that you don’t even use it. 

Of course, you know best what works for you and what doesn’t. 

But some problems might not be as obvious as, say, repeated claim denials for dubious reasons. If you’ve never had to call your insurance company for any reason, for example, then you may have no idea how helpful — or unhelpful — their customer service department is. 

Take some time to think about your health plan and how it’s working out this year so far. You might notice a pattern. And when open enrollment comes around again, you’ll be better prepared to narrow down your options.

What to look for in a health plan

With that handy list you made of your health plan’s red flags, it’s time to problem solve. 

  • Premiums too high? Set a budget for what you’re willing to pay each month. That will help you focus on plans in that price range. 
  • Atrocious customer service? Call a few competing insurance companies and have a chat. Get a feel for what they’re like.
  • New allergy diagnosis? Look for a plan with extensive coverage for specialists in your area.

Look at all the things you don’t like about your plan, and use that info to make a more informed choice about your coverage for next year. 

Write it down. Save it somewhere. 

And don’t forget to update the list over the next few months. Taking stock mid-year is a good way to stay on top of an otherwise daunting task. But things might crop up. Jot them down and save them with your other notes. Then, when open enrollment starts in November, you can pull up the list and hone in on what you need and want.

Bonus? You’ll have plenty of time to find that stuffing recipe while still prioritizing your health insurance. Win-win.