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Shopping for your most ideal health insurance plan can be stressful, to say the least. There are a multitude of options, many of which seem very similar on the surface. But when you dig deeper, you may well discover that they're far more different than you at first supposed.
Finding an affordable policy, perhaps offered through your employer, and one with a reasonable deductible and copay, is certainly a big part of your overall health insurance goals.
But here are some other important factors that are too often overlooked by those looking for health insurance.
Can I Keep My Preferred Doctor And Not Be Penalized?
With many health insurance plans, you have to use a specific network of physicians to be covered at all OR to get the full benefit of your insurance at least.
If you already have a preferred local doctor, be sure to check which (if any) plans include him/her in their provider network. Also, research other doctors and health care facilities in the network. Read online reviews, check up on them at the AMA, and learn their locations and hours of availability.
Finally, if you need a specialist, find out if that will be covered in-network as well. And find out if you need to always see your primary care physician first for a referral or what's the procedure for using a specialist.
What About My Pre-existing Conditions?
Since the ACA took effect, you can no longer be turned away by most insurers for a preexisting condition. But, some insurers offer short term plans that do still require a series of health questions and approval before the coverage will issue. Short Term Medical plans can be much more affordable than ACA compliant health plans and are easier to acquire during the middle of the year (ie. when the Federal Open Enrollment Period is closed), so for individuals without an ongoing health condition these can be very good options. If you do have a condition that was diagnosed or for which you’ve received treatment in the last 12 months, then a more traditional medical plan that is compliant with the ACA would probably be better for you.
Regardless, you really need to investigate the details of how each potential insurer handles any preexisting conditions you may have. Seeking the help of a knowledgeable advisor who can guide you through your insurer choices is a very good idea.
Be Sure Everything's Covered That You Need To Be
Not every plan covers everything in the same way or to the same extent. ER and hospital care is probably covered in some sense, but you have to dig into how the insurer defines "emergency" and what the patient’s out of pocket costs would be, should a major health event occur. If you are or may become pregnant, you also should not neglect to investigate what kind of OB/GYN, prenatal, and birth care coverage is included. It could make a big difference.
Many, but not all, policies will cover regular physicals and health screenings as this was part of the ACA regulation. This would include child immunizations and well child visits. But again, not all plans cover these services the same way.
Another area of concern that comes up quite frequently is mental health and behavioral care. The Mental Health Parity and Addiction Equity Act was passed to ensure that most health plans will treat these kinds of conditions like they would any other covered illness. There are exceptions however so it’s best to not assume something is covered - ask about it.
Finally, for those who regularly spend a lot of prescription drugs, you need to find out if prescription drugs are covered (and if so, how well) by any prospective health insurance. It's possible you could save yourself some money by using a separate drug discount program instead of wrapping it all into your regular health insurance, but it will take crunching some numbers to discover which approach will likely work best for you.
Given the complexity of today's health insurance market, the high cost of healthcare, and the fact that the law requires you to be insured, there's a lot of confusion and a lot of pressure in shopping for a new health insurance policy.
Contact us at Summerlin Benefits Consulting, and we can help you better understand your options and assist you in finding your ideal health insurance policy!