Which health insurance will you choose?
On the surface, it’s a simple question — but it’s one that can be fraught with much anxiety.
For those who have health coverage through work, the process can be as simple as reviewing your company’s health plan comparison sheets, calling your benefits hotline, clicking a few buttons — and voilà, you’ve made your elections.
But for all those self-employed people out there — contractors, freelancers and all-around one-man bands — choosing a health plan isn’t quite so easy a process.
It can feel more like you’re working on a senior thesis, with all the fact-finding and research you have to do. But instead of gaining more clarity, you can often end up more confused than when you started.
Metal plans? HMOs? Coinsurance? Oh, my!
To show just how difficult it can be, we asked two self-employed people facing vastly different health care choices — one wants bare-bones solo coverage, the other has to cover a family of four — to share the difficulties they’re encountering in choosing a health plan for 2016.
Then we asked Sarah O’Leary, founder and CEO of ExHale Healthcare Advocates — a Dallas-based company that helps consumers and businesses navigate their health care options — to offer advice on what factors should come into play with their decision-making.
Her guidance could help those of you out there who can’t just run down the hall to pick your resident HR rep’s brain.
“You only qualify for a catastrophic plan if you’re under 30 or you are over 30 and can certify that you can’t afford coverage or are experiencing financial hardship,” O’Leary explains.
So Rick’s most-affordable option would likely be a bronze health plan, a category of ACA coverage that tends to have low premiums but pays for only 60 percent of medical costs, on average.
Premiums can vary greatly by region or state, but O’Leary says Rick could find comparable bronze plans on the California health exchange and on the open market — adding that there could be one administrative advantage to shopping off the exchange.
“When people are sure they aren’t going to receive subsidies, they’ll sometimes choose to go on the open market because you don’t have to fill out the same [type of] application that’s necessary for HealthCare.gov or the state exchanges — it’s just a little bit easier,” she explains. “But you have to make sure it’s a legit, quality plan that meets minimum ACA requirements or risk getting penalized through your taxes.”
If Rick doesn’t travel much outside of his immediate area, he could save further by choosing an HMO bronze plan, O’Leary suggests. HMOs typically offer low premiums because they cover only in-network doctors, but they often have restricted service areas.
If he goes the HMO route, Rick could potentially reap some tax benefits by opening a health savings account. That’s a type of account to which he can contribute pre-tax dollars to cover medical costs — as long as he has a high-deductible health plan.
O’Leary suggests one other avenue Rick could explore: “If he belongs to a professional association or union, [he should find out] if they offer a health plan, which might be another way for him to save money [on his health care costs].”
“People are feeling the pinch [of costs], so they don’t want to spend a lot on premiums,” O’Leary says. “But we encourage them not to let that cloud their judgment. [Many factors] fit into the equation of what makes a quality plan for you.”
Even if Yoon sticks with her current plan, changes are afoot — so it’s important that she confirm that her family’s preferred doctors will continue to be covered.
“Don’t just take the website’s word for it. Call up your doctors and make sure they’re in-network,” O’Leary suggests. “And when you get your insurance card in January, double-check and triple-check that info, because you have a small window to appeal if you feel they’ve changed the network since you signed up.”
Ultimately, O’Leary says that if Yoon has been happy with her coverage, her plan remains affordable, and she doesn’t anticipate big surgeries or procedures, she shouldn’t feel pressured to switch.
O’Leary does, however, offer up a strategy that could potentially help lower the cost of Ronan’s annual elbow X-ray.
If Yoon’s plan doesn’t cover it at 100 percent, she can shop around to see how much that same X-ray would cost at different imaging centers, or use a site likeHealthcare Bluebook to do a price search in her area. She can then use that information to negotiate the price up front at a chosen facility.
“[People don’t realize] the amount of negotiation that can be done for non-emergency tests and procedures,” O’Leary says. “The money you could save by being a smart shopper can be significant.”