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Sonoma Family Life Magazine

The Health Insurance Shuffle

Oct 29, 2019 03:11PM
By Sandra Gordon

Should you change your health insurance plan? Which plan offers the best deal? Now’s the time to find out.

Open enrollment, the once-a-year period when the federal government, thanks to the Affordable Care Act (ACA), allows consumers to choose a health insurance plan or select a new one, begins this year on November 1 and runs through December 15. Health-care coverage applied for during this time will start January 1, 2020.

The ACA features insurance marketplaces or “exchanges” in every state. (Go to Covered California at coveredca.com to find the California marketplace.) These online marketplaces are where consumers can go to compare and buy individual health insurance plans. The following tips can help simplify the process of choosing a plan.

Consult experts. Shopping for health insurance, even using the exchanges, can be confusing. Don’t go it alone. If you have a question about which health plan to choose and what the lingo means, visit healthcare.gov and click on “find help.” You’ll be directed to an enrollment health specialist—a certified application counselor who can answer questions and help you enroll in California’s insurance exchange program.

Or, even better, get a consultation with a certified insurance broker; this service is also accessible through the “find help” option. An insurance broker is a licensed and certified professional who has gone through federal training to understand the ACA and the financial implications of the various choices. A broker can help you choose the best plan and offer an opinion. Brokers receive a commission from insurance companies for their services, which are free to consumers. “There’s no discount by skipping a broker, so you might as well take advantage of their expertise,” says Katherine Woodfield, author of Don’t Buy THAT Health Insurance: Become an Educated Health Care Consumer (Dog Ear Publishing, 2012).

Focus on health plans with the highest deductible. The ACA offers four plan types. Bronze, which has the lowest monthly premium, features insurance coverage for 60 percent of health-care costs, with 40 percent paid by consumers. It is followed by Silver 70/30 Gold (80/20), and Platinum (90/10). The latter has the highest monthly premium. Each type offers standard health benefits. They include preventive and wellness visits, including chronic disease management, and maternity and newborn care; mental and behavioral health treatment; services and devices to help people with injuries, disabilities, or chronic conditions; lab tests; pediatric care; prescription drugs; and outpatient care. Higher premiums do not include more benefits.

Woodfield recommends choosing a health plan with the lowest premium, i.e. one in the Bronze category. Her motto is “Keep fixed expenses low. In other words, pay the lowest premium possible, so you’ll have the least amount of money automatically going out of your pocket every month. When you pay the lowest monthly premium possible, you’ll pay less overall in medical care expenses.”

Skeptical? Do the math. Let’s say you call your doctor and pharmacist to get the full retail cost of each of your doctor’s visits, blood tests, and medications. (Woodfield advocates actually doing this.) If your total medical costs for the year add up to $6,000, on the (60/40) Bronze plan, you’ll have to pay 40 percent of those costs, or $2,400 and your premium, at say, $100 per month, will be $1,200 annually, for a total of $3,600. If you’re on the (70/30) Silver plan, with a $200 monthly premium, you’ll pay $1,800 in medical costs and $2,400 in premiums, for a total annual cost of $4,200, and so on.
Get the idea?

Monthly health insurance premiums never go away, but medical service costs do. The maximum out-of-pocket limit for an ACA Marketplace plan for 2020 is $8,200 for an individual plan and $16,400 for a family. The Bronze plan will allow you to meet your deductible faster.

Choose a plan that includes your providers. If your doctor isn’t listed as a provider for a health plan you’re considering, call the doctor’s office to see if she or he will be signing up with the plan, Woodfield says. Providers can change the plans they participate in, and they often do. But if your doctors don’t accept the health insurance plan you’re considering, pick a different plan or change doctors.

Sign up for a Health Savings Account. To manage health-care costs, Woodfield also suggests enrolling in a health savings account (HSA), which is a fund that may only be used for qualified medical expenses. Then, pay for healthcare that isn’t covered as you go, just like you do for groceries or gas. The IRS deems what’s an acceptable medical expense for an HSA, and its list includes more services than what a health insurance company will cover. Visit healthcare.gov/glossary/health-savings-account-hsa/ for more information. If you’re not eligible for an HSA, a personal savings account designated for medical expenses will do. 

Sandra Gordon is an award-winning freelance writer.