Cancer Rights Attorney, Advocate Reminds People to Investigate Health Insurance Options

November 3, 2020
Monica Bryant

CURE, CURE® Fall 2020 Issue, Volume 19, Issue 4

From Nov. 1-Dec. 15, consumers can shop for health plans offered under the Affordable Care Act. One advocate suggests that all patients compare policies to ensure the best fit for their particular needs and budget.

Taxes, physical exams and oil changes are a few of the items on our “To Do” list each year. One more item, however, should be added: Review your health insurance options.

Under the Affordable Care Act (ACA), former President Barack Obama’s health care law, Americans have more options for health insurance and consumer protections than ever before. Yet few of us are ever taught how to choose the right health insurance plan.

The ACA created the health insurance marketplace (aka exchanges). A lot of confusion exists about this group of exchanges, with many people mistakenly believing the plans are government insurance. They’re not. Private health insurance companies sell their plans through the marketplace.

So why, then, would someone buy a plan through the marketplace instead of just going directly to the health insurance company? Purchasing health insurance through the exchanges offers several benefits, as follows:

  • Every plan must offer comprehensive coverage of essential health benefits, such as hospitalization, prescription drugs and mental health care.
  • Companies must provide information about each plan in
    a standardized format called the summary of benefits and coverage (SBC). Because every SBC has the same format, it makes it easier to compare choices.
  • Marketplace plans have standardized levels: platinum, gold, silver, bronze and catastrophic. The difference between these plan levels is the amount of money that consumers pay out of pocket for their health care costs (i.e., cost sharing).
  • Consumers may be eligible for financial assistance based on their household size and income level (i.e., premium tax credit and/or a cost-sharing subsidy).

But you can only buy a policy through the marketplace during the open enrollment period. For most exchanges, open enrollment this year will run from Nov. 1-Dec. 15. Because these are calendar-year plans, coverage will not start until Jan. 1, 2021, so patients should make
sure they have some other type of coverage until then. Some states may have a longer open-enrollment period. For more information, visit https://triagecancer.org/ health-insurance-state-laws.

The only way to purchase a policy outside of open enrollment is if someone experiences a life-changing event, such as losing their job, getting married or moving to a different state. In those instances, a special enrollment period allows 60 days to shop for and buy a marketplace plan.

Even for those who already have a health care plan that works for them, it’s always still a good idea to investigate and compare different plans. Shopping around can’t hurt, even
for those who have health insurance coverage through their employer. Plans and pricing can change every year, so it may be possible to find new coverage that is more affordable or a better fit for a patient’s needs, e.g., by including specific providers in the network or covering certain prescription drugs.

By taking the time to compare your current plan with new options, you may find a cheaper plan or discover that you’re entitled to other benefits, like financial assistance.

Consider these five key questions when choosing a health insurance plan:

1. What is the monthly premium?
2. How much is the deductible?
3. What is the out-of-pocket maximum for the year? 4. Are my health care providers included in the plan? 5. Are my prescription drugs covered by the plan?

To calculate the true cost of a health insurance policy, multiply the monthly premium by 12 to get the yearly cost and then add the out-of-pocket maximum. The total is the most you will pay for the year to use in-network, covered services.

To review the available plans on the health insurance marketplace, visit HealthCare.gov and enter the state where you live.

If you feel confused or overwhelmed, you’re not alone. Numerous studies show that a majority of Americans do not understand health insurance, so it’s no surprise that people may not be using their policies to maximum potential. To further compound this confusion about the health care system, things are frequently changing at the state and federal levels and people often don’t know where to turn for reliable, unbiased information. For more information and free resources, visit https://triagecancer.org/healthinsurance.

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