Policy Makers
Identifying the right health insurance can be intimidating, but few decisions are more vital to your wellness and happiness. Here are some basics of modern-day healthcare.
BY Linda Childers PHOTOGRAPH by Levi Brown; STYLING by Angela Campos
Few life purchases are as important as health insurance, yet choosing a plan that’s right for you can be a confusing experience. “Cost is only one factor,” says Stephanie Cohen, co-founder of Golden & Cohen, a Washington, D.C.-based benefits consulting firm that helps families get paired with the best coverage available to them. “Consumers need to understand their healthcare needs and keep in mind their potential future needs.”
Cohen says people often select insurance plans based on monthly co-insurance premiums, yet she recommends also looking at deductibles and determining how much you can expect to pay in a given year. “When you’re choosing a plan, you need to look at the worst-case scenario,” says Cohen. “In the event of a health emergency, will you be able to cover a deductible of $3,000 or more, plus out-of-pocket expenses?”
Cohen says it’s also very important to look at coinsurance, medication benefits, and provider networks when you’re selecting a health plan, whether the plan is yours or that of your spouse. Here are some of the basics that Cohen recommends women know about health insurance plans.
EMPLOYER HEALTH INSURANCE PLANS
More employers are cutting back on health insurance benefits, or requiring employees to pay a portion of their health insurance costs. According to the Millimanhealthcare costs for the typical family of four exceeded $20,000 in 2013, and are expected to exceed $22,030 this year. The employer pays about $12,886 in employer subsidy, while the employee pays the remaining $9,144, which is a combination of $5,544 in payroll deductions and $3,600 in out-of-pocket costs.
When you’re choosing a health plan during your company’s open enrollment period, you will typically be offered one of three types of plans. The first is a health maintenance organization (HMO), requiring you to choose physicians from a selected network, and offered at a more affordable cost.
Second is a preferred provider organization (PPO), where you pay a higher premium but have a larger selection of doctors. Third are point-of-service plans (POS) that combine elements of HMOs and PPOs (giving you more doctors to select from, but requiring that you pick a primary care physician who gives will then give you referrals for specialists.
AFFORDABLE CARE ACT (OBAMACARE)
Beginning in January 2014, those who are self-employed or aren’t covered by a company health plan can buy insurance directly from the Health Insurance Marketplace. By visiting healthcare.gov, you can find the marketplace in your state and determine if you can get lower costs on your monthly premiums or if you qualify for lower out-of-pocket costs.
Cohen says highlights of the Affordable Care Act include: Allowing parents to keep their adult children insured on their health plan until age 26. F Requiring health plans to cover essential health benefits such as outpatient care, emergency services, hospitalization (such as surgery), maternity and newborn care, mental health and substance abuse services (including counseling and psychotherapy), prescription drugs, laboratory services, rehabilitative services and devices, preventive and wellness services (including blood pressure, cholesterol, and immunizations), and pediatric services.
Pre-existing conditions will be covered. Health plans will not be allowed to deny consumers or charge them more for having conditions, including pregnancy and chronic disabilities. Instead of a variety of cost-sharing options, consumers can pick from four plan types on the Health Insurance Marketplace.
Bronze plans will pay for 60 percent of medical expenses; silver plans pay 70 percent, gold plans 80 percent, and platinum plans 90 percent. Out-ofpocket expenses for which consumers will be responsible will be capped at $6,350 for individuals, and $12,700 for families.
HEALTHCARE CRIB SHEET
Confused about how to choose the best health insurance plan? You‘re not alone—these resources can help you to determine potential costs and how much coverage you might need. F Compare different health insurance plans for individuals and families, as well as vision, dental, and accident insurance via Medicare plans at ehealthinsurance.com.
This site allows you to compare several plans at a time across different categories and exceptions. If you have questions or need additional assistance, consider working with a health insurance agent. Because they work with insurance companies, their services are free to consumers. Since these agents work with multiple insurance carriers, they can help you save money and determine the best policy for your individual needs.
To find an agent in your area, visit agent-finder.org. If you are researching rates for specific insurance carriers, you can find carrier names on your state’s Department of Health site. Are you helping a parent or older relative navigate the healthcare system? For questions on Medicare, for those 65 years-plus, visit medicare.gov.
This site offers information on nursing homes, medical equipment and supplies, aid for healthcare and medication costs, and how to purchase more insurance for items such as travel outside the U.S.
