Engage: Blog

Kathryn Paez | Oct 2014 | 0 COMMENT(S)

In addition to announcing the release of the Health Insurance Literacy Measure, AIR also identified several items that are critical for consumers when choosing a health insurance plan. Here is the Consumer Checklist for Choosing a Health Insurance Plan:

  • Take time to read each health plan’s summary of benefits and coverage (SBC). Think about what medical services you and your family routinely use to make sure those services are covered. Preventive services, such as an annual physical or a flu shot, usually are covered 100 percent without any out-of-pocket costs to you.
  • If you don’t understand health insurance terms or the SBC, get help. A guide to health insurance terms, or glossary, is available at www.healthcare.gov. Talk to a marketplace navigator or assistor or call the health plan to get answers. Don’t assume you know everything about health insurance, ask questions.
  • Carefully look at the cost-choice trade-offs before choosing a plan. Lower premiums generally mean less provider choice and more out-of-pocket costs when you receive care.
  • If you want to keep your doctors or prefer a certain hospital, make sure they are in-network providers or you usually will have to pay more or all of the cost of your care.
  • If you have a major illness or injury, will the health plan you chose protect you financially? Can you afford to pay a $5,000 deductible if you need to be hospitalized, or would you rather pay a higher monthly premium and have a lower deductible?
  • Estimate your family’s out-of-pocket costs for the year—for example, how many prescription drugs does your family routinely use? Do you or your family have any chronic conditions that require regular doctor’s visits or other services?
  • If the plans you are considering have deductibles, make sure you understand what counts toward the deductible. Often, copayments for physician visits, prescription drugs and other services don’t count toward the deductible.
  • To help estimate your out-of-pocket costs, use an online calculator to estimate what deductibles, copayments (a fixed-dollar amount for a service) and coinsurance (a percentage of the total cost of a service) you will have to pay before the health plan pays for your care.
  • Make sure you understand the rules for out-of-network coverage. Once insured, check to make sure the providers you want to use are in-network or expect to pay more.
  • Once insured, don’t assume your doctor knows the details of your coverage. Call your health plan member services to ensure you understand what’s covered.  Member services may be able to recommend a lower-cost provider that offers the same or better quality services.