10 ways to be a smarter health-insurance consumer
Whether you are insured through your employer, the Obamacare marketplace, or Medicare, choosing the right plan is only the start of being a wise health-care consumer. It's now open-enrollment season for the marketplace, Medicare, and most employer plans, so you may be seeing a lot of advertising on the subject. Here are 10 tips to help you get started selecting a plan and then getting the most out of it:
Whether you are insured through your employer, the Obamacare marketplace, or Medicare, choosing the right plan is only the start of being a wise health-care consumer. It's now open-enrollment season for the marketplace, Medicare, and most employer plans, so you may be seeing a lot of advertising on the subject. Here are 10 tips to help you get started selecting a plan and then getting the most out of it:
Read your options carefully. Even if you are choosing the same plan you had for 2015, there could be changes to it for 2016. Make sure you look at all features before you make a choice. Most open-enrollment materials have a benefits phone number for enrollment questions. Don't guess or assume; call that number for answers to those questions. Most people can make changes only during open enrollment, so getting it right is important.
Take stock of your medical needs when choosing a plan. If you anticipate needing medical treatment in 2016, or if you have a chronic condition, a plan with a lower deductible or no deductible may be worth the extra premium. Assessing your medical needs can also help you make decisions about putting money into a flexible spending account. This is an option many employers offer in which money deducted from your paycheck on a pretax basis can be used for out-of-pocket medical costs. For details on what is covered, visit this.
When you start your 2016 coverage, make sure you have a member handbook. It gives you valuable information on what is and isn't covered, as well as on your out-of-pocket responsibilities. Depending on the type of employer group, the handbook should be available through the insurance company or your human resources department. It isn't the most exciting reading, but it is the most important to become a knowledgeable health-care consumer.
Don't depend on your insurer's website to find in-network providers. Use the website as a guide, but call your insurer's member services department and the provider's office to verify network status. Providers may leave or join networks, and website information is not always up to date.
Never ask a doctor or hospital: "Do you take my insurance?" Any provider will "take" your insurance. But if they don't participate in your network, they can bill your insurance, plus bill you for any balance above the insurance payment. You will also incur higher cost-sharing (co-pays, coinsurance, deductible) for out-of-network services.
Ask the provider's office whether they participate in your specific network, supplying as much detail as you can from your insurance card. And call member services at your insurer to verify the information. Write down the representative's name and the call-center location, so you have a record if you run into coverage problems later.
If you are having laboratory services, especially in a doctor's office, ask where the specimen is being sent. Just because you're seeing a participating doctor doesn't guarantee that the lab work is going to a participating lab.
Keep your current insurance card with you wherever you go. File the old one away to avoid confusion and potential billing problems.
When you are planning to undergo a medical procedure, ask your doctor about all the services that will be involved. Will there be an assistant surgeon? Who is the anesthesia group? Find out whether they are in your network. If not, you may be able to negotiate charges up front or ask whether the same service is available from in-network providers.
Call your insurer before the procedure to see whether it will make a "gap exception" to cover services at a higher level if there are no in-network options available.
The Affordable Care Act mandates coverage for many preventive services including certain screenings and immunizations. There's no patient cost-sharing for these services if you see an in-network provider. (Visit healthcare.gov for the full list.)
When you travel, it's a good idea to purchase travel insurance. Though you should be covered in or out of network for true emergencies, coverage is often insufficient for unexpected charges. This is especially true of ambulance charges, out-of-network balance bills, and charges for services abroad. If you are on Medicare and travel abroad, travel insurance is critical because Medicare does not provide out-of-country coverage.
Mauree Miller is a consumer health-care advocate in the Philadelphia suburbs and author of "The Consumer Playbook," available on Amazon.com.