Your Healthcare Guide

How to Optimize Your Health Insurance Plan

health-insurance
Istockphoto

Q: Its open enrollment season for health insurance. What should I compare policies on to make sure I get the best one for the price?

A: Generally, you want to look at price, coverage, and ease of use. Clearly, affordability should weigh heavily in your decision, but don't let that be the sole criteria. "Costs are much more than premiums," says Leslie Fried, director of the National Center for Benefits Outreach and Enrollment and director of policy and programs for the National Council on Aging.

If you have a preferred doctor, make sure he or she accepts the plan you're considering, says Frederic Riccardi, director of Client Services at the Medicare Rights Center. Also, look at the prescription drug costs in the plan and whether the drugs you take are actually covered, the deductible you have to pay before benefits kick in, and the overall amount you can be expected to shell out in any given year.

If youre in good health and single, you can save money by picking a low-cost, high-deductible plan that will cover you mainly for major procedures. However, if you go to the doctor a lot or have kids, dont make the mistake of picking a cheap policy only to later discover that it only covers major injuries or catastrophic illnesses. In the new Insurance Marketplace, established as part of the Affordable Care Act, the Platinum Plan offers the highest premium with the highest coverage. The Bronze Plan offers the lowest premium but also the least amount of coverage, with the individual paying 40% of medical services, says Fried.

On the coverage front, find out what services and procedures are included—as well as which treatments are excluded. Then, figure out how you would fare in a typical year, based on your expected use of benefits, the premiums, co-pays, and prescription drugs you may need. For instance, if you take specific medications, you might choose a plan with higher premiums if the drug costs were low enough to offset it.

Finally, check how easy it is for you to access benefits: How do you submit claims? Is phone or online assistance readily available? And whats the process for seeing specialists or consulting doctors of your choice? Weigh all three of these areas—cost, coverage, and ease of use—on what your likely medical needs will be for the upcoming year, then go with the plan that has the best fit.

And open enrollment happens every year, it's important to review your coverage every year. "If your health status changes, you're going to want to revisit your choices," says Fried.