Insurance. It’s confusing, a hassle, and expensive!

“Let’s be honest. No one likes dealing with insurance. It’s confusing, it’s a hassle, and it’s too expensive.” This statement from a recent commercial from an insurance company is agreeable on several levels. If you are like me, for most of my insurance needs I like to set it and forget it! That is until I need to use it. Then I might be surprised if what I enrolled in does not pay for a procedure or service. It’s a good idea to do an annual review of your health insurance coverage and the best time is during the open enrollment period between October and December. In this blog post, I will be discussing options available for people who are enrolled in employer-based health insurance, retirees and others with Medicare, and those without insurance. So, let’s jump right in. 

Let’s cover those without insurance first.

Going without health insurance can be a bit of a gamble because without health insurance coverage you will be responsible for the complete cost of care if you were to get sick and end up in the hospital. This can cost 10s of thousands of dollars. The first step is to find out what be the best coverage compared to your income. If you are employed then locate the Human Resources department at your employer and ask for information regarding health insurance. The benefit of employer-based health insurance is it will be group coverage which usually means lower cost for the monthly premium you will pay each month to have health coverage. If your employer does not offer coverage or you are not working, then check out the Individual Marketplace or Healthcare.gov. Open enrollment dates to obtain coverage is November 1 – December 15.

The individual marketplace may have subsidized health coverage based on your income. This means there may be money available to help pay for the monthly premium of coverage through tax credits. For most states to be eligible for subsidies your income must be between 100% – 400% of the federal poverty level. If your income is below this amount and your state expanded Medicaid, you may be eligible for no-cost health care through the Medicaid program. To find out what you are eligible for, create an account at Healthcare.gov or go to healthsherpa.com and enter 5 pieces of demographic information to see what is available. If you are not tech-savvy contact your Health Advisor at Pack Health for assistance. There also may be navigators available as well through Healthcare.gov that may be able to help. You can click here for more information: https://www.healthcare.gov/glossary/navigator/.

Secondly, what if I am already covered by my employer with commercial insurance?

I am good to go, right? Not necessarily. Open enrollment is a good time to review your current coverage to see if you are still getting the most for what you are paying. It is a great time to review your health, vision, and dental plans. You may want to change health insurance plans if you spend little or no money during the year in health care and you are healthy then you could choose a low premium plan. The tradeoff is it will have a high deductible. This is the amount you will pay before your insurance will start to pay for services. It could be between $5,000 – $10,000 depending on your plan. Most of these plans will have a Health Savings Account option, so be sure to be saving money regularly into this account to offset the costs if you did get sick. Alternatively, if you are paying more for health care due to managing a chronic condition or two, then it may be time to opt for a higher premium plan with lower deductible and copays. This applies to dental and vision coverage as well. You can sit down and put pencil to paper to help find out how much money you are spending out of pocket each year and see what plans will best suit your individual needs. Also, it is a good time to review other financial healthcare products that may be available like flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA). While these may sound scary to consider, your human resources officer at your workplace can help you to choose what is best for your situation. These are accounts you pay into each month before taxes are taken out of your check to spend on health care needs. The main benefit is twofold. It helps to lower your taxable income and you will be saving money towards healthcare for peace of mind.

What about if I am retired and covered by Medicare?

Medicare is a federal program that covers adults age 65 and above, and in certain situations for younger people. Medicare is divided into 4 different parts and is labeled A, B, C, and D. Part A is hospital coverage, Part B covers your doctor, Part C is Medicare Coverage or Medicare Advantage, and Part D is prescription coverage. Many people may have traditional Medicare with Parts A, B, have a supplemental policy and have an additional Part D plan to cover drugs. The supplemental policy is due to the fact that Medicare Part A only covers 80% of hospitalizations and the supplemental will cover the other 20%.  

Part C or Medicare Advantage is Medicare managed by a commercial insurance company like Blue Cross and/or Blue Shield. The “advantage” is this works like most commercial plans. It covers drugs, hospitalizations, and physicians. You will be responsible for copays like other commercial insurance products. What is the best plan for me? Good question! It depends on if you are using more services or fewer services. If you are well Medicare Advantage could be a good option for someone looking to save monthly premiums and pay as you need it for services. Traditional Medicare with a supplement and a Part D plan could be a good option if you have more than 1 chronic condition, see the doctor often throughout the year, and have prescriptions. You may not be nickel and dimed, and by paying a monthly premium with the supplemental plan picks up the 20%.  

If you need some assistance trying to figure it all out there are programs available in most states to help you see if you have the right coverage or drug plan. The time to act is between October 15- December 7 most years. The State Health Insurance Assistance Programs (SHIP) help people to local, personalized counseling and assistance to people with Medicare and their families. SHIPs can help you with things like answer any Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance. They can provide guidance about joining or leaving a Medicare Advantage Plan (like an HMO or PPO), any other Medicare health plan, or Medicare Prescription Drug Plan (Part D). Click on the link for assistance: https://www.shiptacenter.org/

 

Health insurance can be confusing, a hassle, and it’s expensive. No one likes dealing with it. But with a little information and some guidance or assistance, it can be worth your time and money to see what are the best options for you.

Leave a Reply

Your email address will not be published.