5 Things to Consider When Choosing a Health Insurance Plan

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The open enrollment period for 2022 health coverage runs from November 1^st until January 15, 2022. This is your chance to shop around for a new plan through the Health Insurance Marketplace or update the plan you already have. You must enroll by December 15^th for coverage that starts January 1^st. Here are five things to keep in mind when choosing a plan.

Make sure your current providers are in the plan’s network

Once you find a doctor you love, chances are you want to hold on to them forever. So, make sure your preferred doctors, specialists, hospital, and pharmacy are in the plan’s network. When you go to an out-of-network doctor or facility, you may be fully responsible for the cost of care and spend more than necessary.

If you’re on the hunt for a new doctor, find one that’s nearby and within the plan’s network. Consider the office hours, ask if they’re accepting new patients, check their credentials and read patient reviews. Although everyone has their own opinion, if most people are saying the same things, it’s probably true.

See what prescription drugs are covered

If you’re currently taking prescription drugs for an ongoing illness, you need to make sure that your medications are covered by your plan, or you’ll have to pay out of pocket. Check their formulary (list of covered drugs) to see if yours is on there. Usually, the medications will be categorized by tiers. The lower tiers are usually generic drugs and have the lowest copays. Some plans may require you to try the generic version first or require authorization for brand name medications.

Your monthly premium

Your premium is the amount you’ll pay the insurance company monthly for coverage. If you fall behind on your payments, the insurance company can terminate coverage. Typically, the more benefits your plan offers, the higher your premium. Although health insurance can be pricey, you may be eligible for a premium tax credit to help cover the cost of a Marketplace plan. Your credit is based on your income and household information. Be sure to update the Marketplace anytime you experience a change in circumstance so they can make the proper adjustments. If you receive more assistance than you qualify for, you’ll need to repay the difference when you file your tax return. If you use less, you’ll receive a refundable credit on your taxes.

The plan’s deductible

Your deductible is the amount you’ll pay before your health plan covers the cost. So, if you have a $1,500 deductible, you’ll be responsible for the out-of-pocket expenses until you reach that amount. After you hit your deductible, you may still have to pay a portion of the bill, but your insurance will cover the rest. Usually, the higher your deductible, the lower your monthly premium. This is an affordable option if you are generally healthy. Keep in mind, most health plans must cover preventative care services such as screenings and immunizations at no cost to you.

Be aware of the copay or coinsurance

There are other costs associated with your insurance that you need to know. Even after you reach your deductible, you may still be responsible for a copay or coinsurance. A copay is a flat fee you pay at the time of service or when you pick up a prescription from the pharmacy. Coinsurance is a percentage of the medicals costs you’ll be responsible for paying. Commonly, insurance companies will do an 80/20 split which means your insurance will cover 80% of the bill and you’ll pay 20%.