Pre-S: Open enrollment season has begun! If you are going to enroll in marketplace insurance, you have from November 1 until December 15 to do so. Visit Healthcare.gov to do so. Don’t wait! Start your research and get yourself enrolled.
It’s not enough to just enroll in health insurance. You also need to make sure that you’re getting the healthcare coverage that you need. Because if you have health insurance, but it doesn’t cover what you need it to, how useful is it really? This might take a little extra research and a little more legwork, but it will be worth it once you know you get what you need. Here’s how to make that happen.
Get Clear On Your Needs
The most important part of choosing a health insurance plan is to make sure you’re getting the coverage you actually need. So the first step is to understand your own needs and those of your family.
Do you have medications that you need coverage for?
Do you need access to mental health services?
Are there specialists that you need to see?
Do you plan to have a baby?
What kinds of medical needs do your children or partner have?
Are there other necessary or foreseeable procedures coming down the pike?
Answer these and other applicable questions to make sure that your health insurance plan is the right plan for you.
Look At The Coverage
Look very closely at what is covered and what isn’t covered under the plans available to you. If you’re getting healthcare coverage through your employer, they should have materials that outline coverage in detail. If you have to get insurance from a different source, it’s up to you to look at the details and figure out if it’s right for you. Make sure you look at the fine print to ensure that you are getting what you need.
Look At The Premium Costs
Understand how much the monthly premium is going to be. Can you afford it? Is the coverage so robust that the premium is worth it? It’s important to look at the whole picture. Compare the premium to the coverage, the deductible, and the co-pays. One might offset the other.
Look At The Deductibles
The monthly premium isn’t the only thing that matters when you are choosing a healthcare plan. You want to fully understand your deductible, as well. A deductible is the amount paid out of pocket by you before your insurance provider will pay any expenses. For example, a deductible might be $1,000. That means you have to pay $1,000 worth of medical expenses before your health insurance coverage kicks in. (That doesn’t apply to preventative care, which is fully covered from the start.)
Make sure that you can afford the deductible and that it’s not so high that you’ll avoid getting the healthcare that you need. For me personally, it’s always been important to have a lower (or preferably nonexistent) deductible so that I don’t feel like I need to avoid medical treatment. However, my deductibles have been increasing as of late, so I’ve been taking advantage of FSAs in order to offset the out of pocket cost.
Look At The Co-Pays
Your co-pay is exactly what it sounds like. The amount that YOU are responsible for paying every time you see a doctor or pick up a prescription. The amount of that co-pay will vary depending on your plan. It will also vary based on the type of appointment or medication. It can be a percentage of the overall cost, or a specific number. Make sure to build those co-pay costs into your monthly budget if you will be going to regular appointments.
Take Advantage of FSAs or HSAs
A great way to make sure that you can afford your co-pays and deductibles is to take advantage of an FSA or and HSA. There is a difference between the two, though.
FSA: Also known as a flexible spending account, is an account that you can use to pay for healthcare expenses. This money gets deducted from your paycheck pre-tax and is put on a card or into an account, which you can use to pay for things like co-pays, medical costs that aren’t covered, etc. If you don’t use the available balance by the end of the year, you will lose the money.
HSA: Also known as a health savings account, which is available to people who are enrolled in a high-deductible health plan. It is an account that you can use to pay for healthcare expenses, and it is tax-deductible. If you don’t use the available balance by the end of the year, it will roll over from year to year. You can invest this money over time to allow it to grow tax-free, if you don’t use it on your healthcare expenses.
Ask The Experts
There is so much support and so many resources out there that you should be taking advantage of. If you get health insurance through your employer, there are people at your company whose job it is to answer your questions. Go to them to walk you through your options so that you feel comfortable that you’re making the right decision. If you need to buy private insurance on your own, or purchase through the marketplace, there are still lots of resources at your disposal. Healthcare.gov has a whole “Get Answers” page and you can talk to people and ask questions on the phone. Kaiser also has lots of resources, available in more than one language.
Be Wary of Junk Plans
As was discussed at length in episode 13 of the Money Circle podcast, junk plans are short-term duration plans. They have recently been allowed to be included in the healthcare marketplace, but they do not actually provide good coverage. In some cases, they don’t even cover preventative or emergency care. So avoid junk plans as much as you can.
Certified Financial Education Instructor. Feminist and financial coach for women. Founder of Money Circle.