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Get More from Your Insurance

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With the Affordable Care Act (ACA), also known as Obamacare, now ramping up around the country, the traditional “open season” that gives us a chance to sign up or switch health insurance plans has a few more moving parts this year. Open season now includes three basic categories of health insurance—Medicare and employer health plans, as in the past, and ACA health policies for people who buy insurance on their own, who haven’t been able to afford it or who have been denied coverage. Regardless of the type of insurance you have or need, making the right choices can be complicated. Key points to consider… 

  • Cost. No matter what type of health policy you might be shopping for, one of the biggest mistakes people make is paying more attention to a policy’s premium cost than its actual coverage. In addition to the premium cost, consider the co-payments, deductibles and other out-of-pocket costs you’ll owe if you use doctors, hospitals or medications not fully covered by the plan. These issues apply to Medicare, employer plans (if multiple plans are offered where you work) and to those plans that will be offered via the Obamacare Health Insurance Marketplaces, also known as Health Exchanges. What helps: Make a list of the doctors, hospitals, medications and services you use, and see whether they are covered by any plan you are considering. Then compare the co-pays for those services or any limits on the number of treatments allowed (such as 20 physical therapy sessions per year) for each plan. Add those costs to the premiums before choosing a policy.
  • Does the plan fit your needs? While cost is important, it’s crucial that you opt for a plan that meets your family’s health-care needs. For example, if your 55-year-old spouse has Parkinson’s disease, you can anticipate needing more health services in the future than you did prior to that diagnosis. What helps: Ask your doctor what health services you (and your family members) may need in the next year or two. Use that as a guide to find a plan that best matches your needs.
  • Don’t miss the deadline! Believe me, this is one deadline you don’t want to miss. If you do, you’ll keep your current plan (except in circumstances such as marriage or divorce). Here are the specific dates you need to know: If you’re on Medicare, open season began October 15, 2013, and ends December 7, 2013. If you have an employer plan, open season usually occurs during November and December—check with your employer about it today. If you’re buying an individual or family health policy from a private insurance company or are purchasing through an ACA-created Health Exchange and want coverage to begin January 1, 2014, check Healthcare.gov for the most up-to-date information on deadlines.

Best places to get help: Medicare’s Web site, Medicare.gov, compares various Medicare plans on a state-by-state basis. Or call 1-800-MEDICARE. If you’re shopping for an individual or a family plan under the new Health Exchanges, Healthcare.gov is an excellent resource or call 1-800-318-2596. If you have an employer plan, check with the company’s human resources office.

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Source: Charles B. Inlander, a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care, and is the author or coauthor of more than 20 consumer-health books.  Date: October 17, 2013 Publication: Bottom Line Health
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