With an increasing number of Americans assuming a greater share of their health care costs, getting the most value for your health insurance dollars is more critical than ever.
"This is a new day for health insurance," says Vicki Breitbart, director of the Health Advocacy Program at Sarah Lawrence College. "The Affordable Care Act increases our rights as consumers of health care. Being an informed consumer is the best way to get the most from your plan."
Unlike in the past, consumers are now "guaranteed to get a health insurance plan that has real value" because insurers must cover yearly wellness visits, health screenings and other essential health benefits, says Christine Barber, senior policy analyst for Community Catalyst.
"For years, health insurance plans could offer bare-bone benefits and a huge deductible," says Barber. "People would run out of coverage and be left underinsured with medical debt."
Assess your health care needs
To find the best value, experts advise consumers to begin by assessing their health care needs. Do you have a chronic illness that calls for frequent doctor visits and multiple medications? Do you have a child with special needs who requires ongoing therapy? "It's important to get the health plan that works best for you and your family," says Barber.
Once you fully understand your health care needs, it's time to shop for insurance.
According to Susan Pisano, spokesperson for America's Health Insurance Plans, four factors come into play when determining the value of a policy: the cost of the annual premium, the type of benefits offered, the out-of-pocket expenses and your eligibility for tax credits and subsidies in the new health insurance marketplaces created by the Affordable Care Act.
"Consumers can easily make these comparisons by reviewing the summary of benefits and coverage provided by insurers," she said.
Even "catastrophic" health plans – available to people under age 30 and to some individuals with limited incomes – provide value by protecting you from worst-case scenarios. Although catastrophic plans come with lower premiums and higher out-of-pocket costs, they still cover essential health benefits, including three primary care visits per year and preventive services such as annual wellness visits, immunizations and certain health screenings at no additional cost.
Check out the new marketplaces
Sally McCarty, a senior research fellow at Georgetown University's Center on Health Insurance Reforms, urges consumers to explore the state-based marketplaces (sometimes called "exchanges") that will begin selling plans in October with coverage effective Jan. 1, 2014. Consumers with incomes up to 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four in 2013) can get tax credits toward premium costs. Those with incomes up to 250 percent of the federal poverty level ($28,725 for individuals and $58,875 for a family of four in 2013) can get subsidies for out-of-pocket expenses.
"There certainly is an effort in some states to scare people away from the [new marketplaces]. You hear a lot of horror stories about the cost of premiums," says McCarty. Yet one study by the Urban Institute concluded the marketplaces would offer robust competition leading to reasonably priced premiums. "That's why it's crucial for people to check it out for themselves."
To get the facts, visit U.S. News & World Report's guide to health insurance for information about the health insurance marketplace in your state. Spanish-speaking consumers can visit CuidadoDeSalud.org. Certified "navigators" fluent in hundreds of languages will be on hand beginning in October to help consumers review their options and enroll in a plan.