Understanding Your Insurance: Beyond Price
Everyone likes a good deal, and health insurance bargains abound this time of year. But buyers should look beyond price when searching for a plan. Shoppers also should consider doctor networks and coverage limits to avoid getting stuck with big bills after care.
What to Consider Beyond Price
Deductible
This is the annual amount a patient pays for many covered services before the insurer starts paying a portion of the bill. Plans with low premiums can come with deductibles well over $1,000 for individuals and a few thousand dollars for families. Shoppers should look at the size of the individual deductible and understand where it applies. Regular visits to a specialist can lead to some hefty patient bills.
Are My Doctors Covered?
Insurers form networks of covered doctors and health systems. Some plans may provide no coverage for care sought outside those networks. The federal government’s website for finding insurance plans makes it easy to filter for covered doctors and hospitals when looking for plans, said Emily Bremer, president of a St. Louis-based independent insurance agency, The Bremer Group. Bremer says shoppers should think about more than whether their doctors are in the network. They also should also consider which hospital system they would want to visit if a big emergency happens.
What About Prescriptions?
Insurance plans come with formularies, or lists of covered drugs, that vary by plan. Those lists often group drugs in tiers with different costs for the patient. Shoppers should check to see how a plan will cover the regular prescriptions they already take. Don’t immediately rule out the plan if the bill would be too high. Help may be available. Drugmakers often have coupons or discount programs that can cover patient costs as long as the drug has coverage, Bremer said. Websites like GoodRx also may be an option for getting a price break.
Coinsurance
This is the portion of a bill the patient is responsible for after meeting the deductible. It’s a percentage that can vary. Usually plans with lower premiums leave patients with bigger coinsurance. Coinsurance payments can hurt, so it’s important to know the percentage and the risk you face.
What are the Limits?
Health insurers will start handling all costs for covered, in-network care once you reach a plan’s out-of-pocket maximum for patient spending. That can vary by plan. For coverage sold on the ACA marketplace, that annual maximum cannot be more than $9,200 for individuals and $18,400 for families next year. Those who reach this level of spending may only see temporary relief. Patient spending totals that count toward that out-of-pocket maximum generally reset at the start of every calendar year or if you switch plans during the year.
Conclusion
When searching for a health insurance plan, it’s essential to consider factors beyond price. Understanding the deductible, doctor networks, prescription coverage, coinsurance, and out-of-pocket limits can help you make an informed decision and avoid surprise medical bills. By taking the time to research and compare plans, you can find the right coverage for your needs and budget.
FAQs
Q: What is the deductible, and why is it important?
A: The deductible is the annual amount a patient pays for many covered services before the insurer starts paying a portion of the bill. It’s essential to consider the deductible because it can be a significant expense for patients who need regular medical care.
Q: Can I change my insurance plan during the year?
A: In most cases, you can only change your insurance plan during the annual enrollment period or if you experience a qualifying life event, such as losing your job or getting married.
Q: What is coinsurance, and how does it work?
A: Coinsurance is the portion of a bill the patient is responsible for after meeting the deductible. It’s a percentage that can vary, and it’s essential to understand the coinsurance rate to avoid surprise medical bills.
Q: How do I find a health insurance plan that covers my doctors?
A: You can use the federal government’s website for finding insurance plans to filter for covered doctors and hospitals. You can also contact your current doctor’s office to see if they participate in the insurance plan you’re considering.
