Open Enrollment for Obamacare is here.
You know it’s time to choose a health insurance plan for the next year, but there are so many choices it can make your head spin! How can you distinguish between all the plans available? What should you be looking for to find the right plan?
In reality, the plans have more similarities than differences. All of them must include the 10 Essential Benefits outlined above. But there are some key factors you need to consider when comparing plans.
6 Key Variables to Consider When Comparing Health Insurance Plans
1. Provider Network. We lead with the most important (but sometimes overlooked) factor you need to consider. One of the biggest unintended consequence of the Affordable Care Act was the way it impacted provider networks.
Most provider networks shrunk as insurance companies re-negotiated contracts with hospital systems and other providers. It is very important to be sure that your doctors (and your preferred hospital) are included in a company’s network before enrolling in coverage.
2. Deductible. The deductible is the amount of money you pay before your policy begins paying claims for something not covered by a copay. You will usually see two numbers – one for an individual and one for a family (usually twice the individual deductible). Individual Deductibles will typically range from $1,000 to $6,600.
3. Maximum Out-of-Pocket (MOOP). This number is actually more important than your deductible. The MOOP is the maximum amount of money you’ll have to pay for covered healthcare in a year. Once you’ve reached your deductible, you will often have what’s called a “coinsurance” arrangement of something like 80/20 or 50/50 or something along those lines.
Once you’ve reached your MOOP, you are finished paying and the insurance company will pay 100% of your covered claims. Everything you pay (including copays) is included in calculating your MOOP. The maximum MOOP allowable by the law in 2015 is $6,600 for an individual and $13,200 for a family.
4. Copays. While sometimes overrated, you will see differences in the copays available on health insurance policies in Obamacare. You will almost always see a difference between primary care doctors (usually including pediatricians and OBGYN) and specialists.
Not all plans provide a copay. If you don’t have a copay, you’ll pay the company’s negotiated rate for an office visit, and it will count towards your deductible.
5. Prescription Drug Coverage. While the law requires that prescription drugs be covered, not all plans cover all drugs. Each company will have a “formulary” that lists the drugs that are covered. Many plans will include a copay for prescription drugs. These copays are broken into 3-5 tiers, which typically include generic drugs, preferred brand name drugs, non-preferred drugs, and specialty drugs.
If you don’t have a copay, you will pay the company’s negotiated discount for a covered prescription and it will count towards your deductibtle. If you take prescriptions regularly, you’ll want to check the formulary to make sure your prescriptions are covered.
6. Price. We list price last on purpose. For many people, this is the only variable they consider when comparing health insurance plans. But the lowest priced plans often make compromises in other areas – often by having a smaller provider network, for example. The low-price plan may work just fine for you, but it may not. So consider all of these factors before making a decision.
Most insurance companies provide online resources that allow you to search their provider directories and drug formularies. You’ll see the other variables clearly labeled in whatever marketplace platform you use to shop and enroll.
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