1
Talk the talk. Like most industries, health insurance has its own lingo, such as deductible, copay, coinsurance and network. If you’re not sure what these terms mean, get familiar with them. “Shopping for health insurance without knowing the language is like learning how to ask where a museum is in French when you’re traveling in France, then not having enough vocabulary to understand the response,” says Robin Gelburd, president of FairHEALTH, a nonprofit organization with a mission to bring fairness and transparency to health insurance information. To get the gist of standard health insurance terms, check out the glossaries on fairhealthconsumer.org and healthcare.gov. Print a cheat sheet of insurance definitions for your reference.
2
Pick a metal. Healthcare.gov offers four health plan types from which to choose: Bronze, in which 60 percent of health care costs are covered by an insurance company and 40 percent is paid by you, the consumer, with the lowest monthly premium; Silver (70 percent covered/30 percent paid for by you); Gold (80 percent/20 percent paid for by you);
Family Health
Open enrollment, the period when the federal government allows you to choose a health plan or to select a different plan if you already have health insurance, runs from November 1, 2016, through January 31, 2017. But you can enroll at other times of the year if you get married, have a baby or lose coverage. Medical care continues to be expensive, with lots of potential costs at risk. To pick the right plan for you and your family, take these healthy steps.
and Platinum (90 percent of costs covered, with 10 percent paid for by you, with the highest monthly premium). There’s also catastrophic coverage, which pays less than 60 percent of the total cost of care on average. It’s only available to those under 30 or who have a hardship exemption. “Focus on the cost of the monthly premium to select a metal level plan you can afford,” Kelly says. Buying health insurance that’s beyond your budget is a deal breaker. If you can’t keep up with the monthly payments, you’re not going to keep it. Note: The Silver level plan is the only one that subsidizes your health insurance expenses. If you qualify based on your income, it can reduce your out-of-pocket costs.
3
Next, choose a plan with providers you currently use. Once you’ve picked the metal level plan you can afford, ask yourself: Do my current providers accept this health insurance? In other words, are the physicians and hospitals you like and use in the health plan’s network of providers and facilities? If you’re having a baby and anticipate needing an epidural or a C-section, you also want to know the anesthesiologist you end up with is in-network too. Bottom line? To keep medical costs low, it pays to stay in-network with all of your providers.
4
Do the math. As you’re narrowing the field, compare the products and services that each contender health plan offers. What will you pay for a medical service? When you visit the doctor, what will your copayment be? What’s the deductible? To estimate your health care expenses with any potential carrier, go online to your current carrier and look at last year’s claims for medical tests, doctor’s visits and prescriptions. Last year’s medical expenses are a good indication of what this year’s will be. If you went to the doctor five times last year, plug in what it would cost in each contender plan if you went to the doctor five times this year, and so on. “Arm yourself with the information you need to make a good decision,” Kelly says.
5
Check your work. At this point, you have enough information to pick a decent health plan for your family. Still, your health insurance is only as good as the carrier. If you’re going to need a medical service that’s specific to you, call the carrier’s 800 number before you sign on and ask if they typically cover that procedure. The last thing you want is for the carrier to tell you the service wasn’t medically 2016 | BostonParentsPaper.com
9