‘Tis the season to roll up your sleeves, gather your paperwork, and choose a health insurance plan for 2020. For those looking for their own plans, HealthCare.gov and other state exchanges are open for enrollment from from November 1.
Despite the rhetoric about the implosion of the Affordable Care Act, the demise of the individual mandate, and other attempts to hobble the law, markets are still alive and well. And many people are eligible for grants to reduce their costs.
In fact, HealthCare.gov has gotten sleeker and easier to use over the years (after a rocky start). There are new bells and whistles to make plan shopping easier this year. Still, it’s hard to figure out how to balance premiums, deductibles, and other costs and choose a plan that will meet your needs for the coming year.
Charlene Wong knows this from experience. Even as a physician and academic at Duke University who studies how people make health insurance choices, a few years ago she and her husband picked the wrong plan.
“We spent several days researching plans and calling to make sure the doctors we wanted to see were in network,” she says. Then she got pregnant and discovered that while her OB was networking, there was a catch.
“There was a multi-level network within this health insurance scheme and [my OB] was Tier 3 network providers,” she explains. Even though she thought she had done everything right, she ended up having to change doctors to cut costs.
So rest assured, health insurance can be tricky, even for experts. Here are some tips to help you find the right plan.
1 – Determine where and when you need to register
Depending on where you live, you can either use the federal exchanges on HealthCare.gov or your state’s marketplace to purchase insurance. Twelve states and the District of Columbia operate their own scholarships. Open federal exchange listing runs through mid-December, but you may have more time if you live in a state that runs its own market.
2 – Review plan options, even if you like your current plan
For people who are already signed up for an ACA plan, Charles Gaba says it’s really important to log on and see if there’s better value, even if you’re happy with your current plan. Gaba runs the ACAsignups.net website, where he performs health care data and policy analysis, primarily focused on the Affordable Care Act.
It can be tempting to ignore all the registration hullabaloo, especially since you’ll just be rolled into the same or similar plan if you don’t do anything during open registration.
“A lot of people think that because nothing has changed in their life – for example, their income is the same, the same household – nothing will change for their policy or their premiums, and that’s just not true” , says Gaba.
Every year there can be all kinds of changes that affect the types of plans available and the costs of those plans. For example, this year new insurers have entered the market and premiums have fallen in some states. It’s always worth logging in and checking what has changed for you and if it makes sense to change things.
3 – Compare estimated annual costs, not just monthly premiums
It’s easy to focus on paying the monthly premium when comparing plans, but Wong at Duke says to remember to consider other costs as well.
“A lot of people — we know this from previous research — focus too much on the monthly premium and may not pay as much attention to things like the deductible or the amount of co-pays,” Wong says.
The premium price is highlighted when looking at the plans, but look at the other costs as well. A tool available on HealthCare.gov and some state markets will calculate “Total Estimated Annual Costs” for you. This takes into account the plan’s deductible – how much you have to pay out of pocket for covered services before your insurance pays for it – and co-payments, associated with how much health care you plan to use at the course of the coming year.
Wong says the annual cost estimate can be a very useful tool when selecting a plan. “Trying to figure out the math can be a little tricky, especially for people who aren’t as familiar with health insurance.” she says.
4 – Consider how much health care you use
Choosing the right insurance plan involves guessing how many health issues you’re likely to face in the coming year, which could affect the distribution of costs. Your age is usually a useful indicator for this, but there are always a lot of unknowns, like a surprise cancer diagnosis or a car accident.
Wong points out that there are basic trade-offs to consider. “You might want to ask yourself, ‘Am I paying a little more each month in a monthly premium, knowing that would mean less out-of-pocket expenses when and if I need more medical care?’ she says. “Versus – the other way around – ‘Let me pay a lower monthly premium because I don’t really plan on needing much care, but I know I’ll have this health insurance in case something really catastrophic would happen.’ “
Along with these unknowns, leverage what you know about your health needs. If you have a doctor you like or know you’ll be taking a certain prescription drug, look for a plan that covers it. HealthCare.gov lets you add your provider and prescription drugs when browsing plans to see if they’re covered. Another way to find out is to simply call your doctors and ask them what plans they accept, Wong says.
5 – Beware of plans that are too good to be true
If you see a good deal online, be sure to check out an ACA plan, warns Louise Norris, health policy editor and insurance broker. When researching health insurance on the internet, you may come across short-term plans that advertise much lower monthly premiums, but don’t cover the ACA’s famous ten essential benefits. These include some pretty big things like prenatal care and mental health treatment.
Sometimes people can find great deals on premiums in federal and state markets, Norris says, but if a plan stands out as too good to be true, read the fine print.
“I’ve seen new plans popping up in some regions for 2020 where they’ll say $0 deductible,” she says. “Then you scroll a little further and maybe have a co-payment of $1,000 a day for hospitalization.” You hope not to spend a lot of time in the hospital, but if you do, that kind of cost could really add up.
Norris points to a new tool this year to help sort out the good from the bad – a star rating, similar to what consumers are used to on Yelp or Amazon (echoing Obama’s original vision). Star ratings are based on information submitted by insurers regarding costs, combined with feedback from enrollees.
“The star rating is one of those things at a glance where you can sort of see, ‘OK, how do other guests feel about this plan?'” Norris says. Not all planes have them since some are new, she says, but for planes that do, the stars “give you red flags if there might be concerns.”
6 – Get free help from the pros
The Trump administration has cut federal funding for advertising the open registrations and navigation program, but those programs still exist: there are still people across the country trained and willing to sign people up — for free.
“My best advice for people — especially those less familiar with insurance — is to see if you can get help,” Wong says. You can call for help, but she recommends trying to meet “a certified health insurance navigator or application counselor” in person, she says. “Above all, they are people who are impartial about which health insurance plan is best for you.
Katie Turner is one such skilled navigator — she’s been recruiting people for seven years and works with the Family Health Care Foundation in the Tampa Bay, Florida area. Before open enrollment, she’s been busy calling past consumers, letting them know it’s time.
She advises people to gather all the necessary documents, such as social security cards, immigration documents, tax returns, before going to a meeting with a navigator.
Above all, she says, don’t miss your chance to buy coverage if you need it.
“There’s a lot of confusion out there,” Turner says. Many people don’t know what a legal challenge to the law means for markets (nothing yet), when registration is open, and more. “All we can do,” says Turner, “is continue to be here and provide the resources we’ve provided for seven years to help people sign up for coverage.”