Look beyond the cost of premiums
Avoid the temptation to automatically select the policy with the lowest premium because you may pay more for your health care in the long run. Premiums refer to the annual cost of an insurance plan (usually paid in monthly installments), regardless of whether you access health care services. Plans with low premiums usually have high out-of-pocket expenses to cover deductibles, copayments and coinsurance, so you may be saddled with bills you weren't expecting.
People under age 30 and some people with limited incomes can purchase catastrophic health plans that cover worst case scenarios. While these plans generally have lower premiums than comprehensive plans, they come with high deductibles and out-of-pocket costs so you'll need to be prepared to handle these expenses. These plans will cover certain preventive measures with no out-of-pocket costs to consumers.
Get the coverage you need
Make sure the plan covers the medical care you need, especially if you have a chronic illness (like diabetes, asthma, multiple sclerosis, arthritis) that requires ongoing care. "If you buy coverage just because it's cheap and it doesn't offer the services you need, then you have thrown your premium dollars down the drain," said Pryga.
The same holds true for prescription drugs. Insures must cover at least one drug in every category and class of medications. But your particular medication might not be on the list, leaving you with higher out-of-pocket expenses. "Look at the cost of your medications across various plans to determine which are reimbursed at a higher rate," said Cheryl Fish-Parcham, deputy director of health policy for Families USA.
Carefully examine the provider network
Find out if the plan's network of doctors and hospitals include your primary care physicians and specialists or you might get stuck with the bill. Going outside your plan's network of providers can lead to a hidden cost known as "balanced billing," said Lucia. "Non-network providers will bill for charges that exceed the amount that your plan reimburses for a covered service." Some plans also require a referral to see a specialist and insurer authorization before undergoing an expensive procedure.
Read the fine print
The Affordable Care Act sets a minimum standard of care, known as essential health benefits, for 10 categories. But insurers have leeway in the type and number of services offered in each category. For example, insurers must cover mental health services, but plans will vary on the number of therapy visits allowed per year. "There are going to be scads of exclusions in policies, even with the essential health benefits," said Pryga.
You are not alone
If you're still feeling overwhelmed about shopping for health insurance, take heart. Help is available online at HealthCare.gov (or CuidadoDeSalud.gov for Spanish-speaking consumers), by phone at 800-318-2596 round-the-clock, and in person.
"The Affordable Care Act sets up a system of 'navigators' who will be available on a one-to-one basis to educate consumers about their health insurance options and walk them through the enrollment process," said Vicki Breitbart, director of the Health Advocacy Program at Sarah Lawrence College. "You don't have to venture into the morass alone."
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