by Dr. (Mrs.) Omobukola Olaoye | It is necessary to constantly review and choose the best health insurance plan that most fit one’s current situation and what one can afford.
As of November 1st, you can join or change your health insurance plan for next year. As you may know, the plan changes from year to year. Which is why it’s wise to compare your health insurance choices from different companies before you choose one before the deadline of December 15th. The changes you make to your health Insurance plan will not take effect until January 1st next year.
The health insurance terrane is now all about patient choice, (Fotaki, 2013, Marquand, 2018). Which means our choice of health insurance is contingent on our current situation. When it comes to the choice of the most suitable health insurance plan for me and my family or for you and your family, it is about weighing the cost and benefit in our current situation and choosing that which brings us the most value. People tend to choose acts with maximum expected utility, (Maziak and Ward, 2009; Briggs, 2017). That is, informed people tend to behave in their best interest, hence make rational choices.
Therefore, the goal of this article is to provide information that may assist you in choosing the most appropriate individual health insurance plan as we consider renewing our health insurance. Thank God for the growing ease of access to information through various means of communication and information technology, regardless of inequalities of education and income, hence more people can make informed decisions, in this case the choice of the health insurance that best fit our current situation, (Maziak and Ward, 2009).
Open enrollment is upon us, that means a time when one could make changes to one’s health insurance coverage. These changes include, but are not limited to switching plans, adding a coverage or removing unneeded coverage. Prior to 2014, one could purchase health insurance at any time during the year, however, now, one can only buy health insurance during open enrollment, unless one has a special circumstance such as becoming a U.S. citizen, gaining status as a member of an Indian tribe, moving outside one’s insurer’s coverage area, leaving incarceration, getting married or having a baby. Others include losing other health coverage due to divorce, COBRA expiration, job loss, change in income or household status, aging off a parent’s plan, or losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), (Masterson, 2018; Marquand, 2018). One can get Medicaid or CHIP (federal and state insurance programs for low-income families) at any time of year though. Open enrollment typically starts around November and ends in December. However, some States like California, Colorado, D.C., Massachusetts, Minnesota, and New York have varied start and end dates. So, check your State’s begin and end date for enrollment, (Healthcare Markets).
What to Consider
Although, there is no longer an individual mandate penalty for not having health insurance, (Healthcare.gov), nevertheless, insurance protects one from the unknown in the event of a dramatic change in ones health. As we grow older, our situation changes, life happens. One can be in great health at one point and suddenly fall ill and need major health insurance coverage for such things as broken bones, cancer and/or serious traumatic injuries with no income at the time of the illness. Other factors to consider when renewing one’s current health insurance include one’s educational status; did you used to have student insurance, but now no longer a student? Has your immigration status changed, did you just gain lawful permanent residence; hence now qualify for a subsidized premium? Do you now qualify for State or Federally funded healthcare coverage plan such as Medicare (because you are now 65 years or older) or Medicaid (because you are a low-income and medically vulnerable individual)? Do you now have to travel outside the country more often than before, and would rather have a plan that covers you internationally? Do you now have a medical condition that would make you want to explore going outside the U.S. to seek medical treatment (medical tourism), or do you now need to buy insurance for your family rather than yourself alone? Whatever the reason for the changes in your situation, the health insurance plan of yesterday may not meet your today’s health need.
Peradventure, your situation has not changed at all, you are still in good health, satisfied with your Primary Care Physician (PCP), or no changes in income, it may still be beneficial to re-shop for health insurance. According to the 2016 Research Brief from the Office of The Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services, over 76 percent of Marketplace enrollees in 2016 could find lower premium plans in the same metal level if they re-shopped for coverage in 2017 during open enrollment instead of re-enrolling in their current plan. Similarly, the 2017 ASPE Research Brief reported that, if enrollees stayed within their current metal level, only 2% would have had access to low cost plan coverage with premiums of $200 or less for PY18.
Therefore, it is necessary to constantly review and choose the best health insurance plan that most fit one’s current situation and what one can afford. So, as we plan on renewing our health insurance, what are the key things to look for before making a choice? I know I am not alone; there are so many variables in this delicate decision process.
To start with, assuming our situation has changed from the last time we purchased health insurance; what treatment do we need now? Where we buy health insurance to meet our current medical needs will determine what plans are available to us at a certain cost. What do we look for as we make a choice of a suitable plan to meet our current medical needs within the options of the insurance carrier available to us? Are our medical needs being met by our current PCP? Are we satisfied with the quality of care we receive from our PCP or do we want a change? In fact, I have been in a situation where I must choose another PCP because our PCP became hospitalist rather than continuing the private practice my family is used to with satisfaction over several years. You may need to change PCP because your PCP no longer accepts your health insurance for one reason or another. Hence, based on your current situation, do you want to keep your PCP within the provider network of PCPs available to you or are you in a position to retain your PCP who may no longer be in network with your current health insurer, therefore making you pay Out-of-Network plan? Then, the kicker: do you want more health coverage and willing to pay higher premium for such a plan or are you constrained to choosing a plan with lower premium but a higher out-of-pocket cost because that is all you can afford?
As you sift through all the insurance information for consideration in your current situation, it bores down to which health insurance plan you consider will add value to your family health. What treatment do you need? Is it available and is it affordable? Hence, some people choose to travel outside their country to seek heath treatment (Medical Tourism) because it is the most viable option for them. Do we need short-term, or temporary, health insurance plans outside the open enrollment period? Bear in mind though that these temporary plans provide only limited benefits. What about a managed plan that has a local doctor in a provider network, more flexibility and health coverage that comes with a higher premium, or do you want a plan with lower premiums that comes with a higher-out-of-pocket costs?
The choice is yours. You cannot be declined for an individual health plan, regardless of your health history, and insurance companies cannot charge you more because of your medical conditions. Likewise, health plans cannot cap the amount of your benefits, and they cannot make you pay more than a certain amount out of pocket each year for the health care you receive. Keep in mind, plan categories have nothing to do with quality of care, (Marquand, 2018). So good luck.
AARP. Understanding Long-Term Care Insurance. Retrieved from https://www.aarp.org/health/health-insurance/info-06-2012/understanding-long-term-care-insurance.html
ASPE Research Brief (2016). Health plan Choice and premiums in the 2017 Health Insurance Marketplace. Retrieved from https://aspe.hhs.gov/system/files/pdf/212721/2017MarketplaceLandscapeBrief.pdf
ASPE Research Brief (2017). Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange. Retrieved form https://aspe.hhs.gov/system/files/pdf/258456/Landscape_Master2018_1.pdf
Briggs, R. A., “Normative Theories of Rational Choice: Expected Utility”, The Stanford Encyclopedia of Philosophy (Spring 2017 Edition), Edward N. Zalta (ed.), https://plato.stanford.edu/archives/spr2017/entries/rationality-normative-utility.
Collins, S. R. & Gunja, M. Z. (2018). Premium Tax Credits Are the Individual Market’s Stabilizing Force. Retrieved from https://www.commonwealthfund.org/blog/2018/premium-tax-credits-are-individual-markets-stabilizing-force
CMS. Custodial Care Vs Skilled Care. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-CustodialCarevsSkilledCare-[March-2016].pdf
Fotaki, M. (2013). Is Patient Choice the Future of Health Care Systems? . International Journal of Health Policy and Management, 1(2), 121–123. http://doi.org/10.15171/ijhpm.2013.22
Healthcare.gov. (2018). Exemptions from the requirement to have health insurance. Retrieved from https://www.healthcare.gov/health-coverage-exemptions/exemptions-from-the-fee/
Healthcare.gov. Essential Health Benefits. Retrieved from https://www.healthcare.gov/glossary/essential-health-benefits
Healthcare.gov (n.d). Health Plan Categories. Retrieved from https://www.healthcare.gov/glossary/health-plan-categories/
Healthcare.gov. (2018). 3 things to know before you pick a health insurance plan. Retrieved from https://www.healthcare.gov/choose-a-plan/comparing-plans/
Investopedia (n.d.) Custodial Care. Retrieved from https://www.investopedia.com/terms/c/custodialcare.asp#ixzz5UelElykP
Kirkham, E. (2017). 10 Best and Worst States for Health Insurance Costs. Retrieved from https://www.huffingtonpost.com/gobankingrates/10-best-and-worst-states_b_9030422.html
Lankford, K. (2018). Cost of Employer Health Coverage to Rise 5% in 2019. Retrieved from https://www.kiplinger.com/article/insurance/T027-C001-S003-cost-of-employer-health-coverage-to-rise-in-2019.html
Loffredi, J. (2015). Does Your Health Insurance Plan Cover You While Abroad? Retrieved from https://travel.usnews.com/features/does-your-health-insurance-plan-cover-you-while-abroad
McKelvy, M. (2014). Why Is Group Health Insurance Better Than Individual? Retrieved from http://www.insurancelibrary.com/health-insurance/why-is-group-health-insurance-better-than-individual
Marquand, B. (2018). How to buy individual health insurance. Retrieved from https://www.insure.com/health-insurance/individual-health-coverage.html
Masterson, L. (2018). How to buy an individual health insurance plan. Retrieved from https://www.insurance.com/health-insurance/health-insurance-basics/how-to-buy-an-individual-health-plan.html
Maziak, W., & Ward, K. D. (2009). From Health as a Rational Choice to Health as an Affordable Choice. American Journal of Public Health, 99(12), 2134–2139. http://doi.org/10.2105/AJPH.2008.155382
Miller, S. (2016). HHS Sets 2018 Health Plan Out-of-Pocket Maximums. Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2018-oop-caps.aspx
Norris, L. (2018). Is short-term health insurance right for you? Retrieved from https://www.healthinsurance.org/short-term-health-insurance/
Norris, L. (2018). The problem with association health plans. Retrieved from https://www.healthinsurance.org/blog/2018/06/01/the-problem-with-association-health-plans/
Norris, L. (2018). Who should consider a high-deductible health plan? Retrieved from https://www.healthinsurance.org/faqs/who-should-consider-a-high-deductible-health-insurance-plan/
Speights, K (2015). Looking for cheap health insurance? These 7 steps show you how to find it. Retrieved from https://www.fool.com/investing/general/2015/10/11/the-smart-way-to-buy-cheap-health-insurance.aspx
TN.gov. When to Visit the Emergency Room. Retrieved from https://www.tn.gov/dcs/program-areas/child-health/nurses/er.html
Travel.State.gov (2018). Insurance Providers for Overseas Coverage. Retrieved from https://travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad/insurance-providers-overseas.html
Dr. (Mrs.) Omobukola Olaoye is a Home Healthcare Quality & Management Consultant; Administrator for A Premium Healthcare Solution, Financial Director of ECWA USA DCC.