4 Tips for Health Insurance Open Enrollment

The struggle is real, health insurance is complicated. Many people are frustrated and overwhelmed by the process, which can lead to paying more than you need to, signing up for the wrong coverage or worse no coverage at all. There are 4 strategies you can use to help navigate the process.

1. Know What Your Needs Are

Before looking at options do your homework. How much can you budget for health expenses? (this includes premium AND out of pocket costs) How often do you go to the doctor? Are you taking medications? Does someone need special services or treatments? Do you have a surgery planned?

Planning on having a baby? Jot down which doctors you use as well as medications you or family members take.

This information will determine if you need coverage that falls under the Affordable Care Act, short term medical that can cover you in between jobs and change plans more often, or a PPO/Indemnity plan that pays a specified amount for visits and treatment.

2. Use an Insurance Broker - Not an Insurance Agent

What is the difference? The difference is that a broker has access to multiple types of health coverage as well as multiple companies to quote from.

If the person you use to get a quote only represents 1 or 2 companies, you may not only not get the right coverage but pay too much as well. Think square peg being crammed into a round hole.

Every individual and family have different needs and may not fit the coverage the agent is “selling” to you. Find a broker you have access to AFTER you sign up for insurance, not just a toll-free number to call for questions.

3. Do the Math!

What are your true costs for healthcare? Yes, the premium is the biggest factor people initially look at.

There are ways to lower your premium with higher deductibles and copays, so you save on the front end, but only pay out of pocket if you go to the doctor. Is it better to pay cash for certain services?

There are plans that will reimburse you if you do. Are your doctors in network? This will also determine how much you pay; some plans have benefits for in network and out of network services, some insurance plans will only pay for in network services.

Is your medication covered? Is it cheaper to pay cash for your medication and get a plan that has a lower premium? These are all things a good insurance broker can help you with.

4. Gaps in Coverage

No insurance plan is foolproof. Understand what is covered and what is not covered.

Your insurance broker can help with this but take on the responsibility to know the basics! Deductible, copays, expected out of pocket expenses, how and when to use telemedicine, urgent care instead of the ER.

Know who is in network BEFORE an emergency. Ask your broker for resources. There are many cost savings strategies and resources available to plan for a medical visit or treatment, as well as strategies and resources after the fact.

Knowledge is a power weapon against overpaying for insurance and out of pocket costs. Question EVERY bill you receive and KNOW your rights. A wrong billing code or diagnosis code could result in a claim being denied. Every state/provider has a patient bill of rights that is in the mounds of new patient paperwork you complete anytime you use a new provider. It outlines what you can expect as a patient as well as what is expected from the provider in terms of billing and medical records. Be your own advocate to your healthcare costs.

Article by Janice Kapp

Janice is the owner of JKapp Consulting an independent Insurance Brokerage providing custom insurance plans for individuals, families and businesses.

512.827.8117 | janice@jkappconsulting.com | www.jkappconsulting.com