After nearly three days of comparing individual health insurance plans, I emerged cross-eyed and weary, but with new information that should ultimately be well worth the time it took to procure it.
After spending a few hours with one particular plan, I found myself with three pages of questions, which I ran by both a health insurance agent and an insurance company.
After I got my answers, I discovered three things everyone should know before deciding on a plan:
Coinsurance: Coinsurance can have a major effect on your total deductible. Check out the percentage on your plan. It represents the amount of medical expenses you’ll still have to pay after your deductible is reached. So, if you were counting on your deductible being the maximum you’d lose from your health savings account, think again.
“But wait,” you may be saying. “If I am seeing 25 percent on my plan, do I have to pay 25 percent over my deductible until the end of time?”
Out-of-pocket maximum: Don’t worry—you aren’t paying your coinsurance forever. Be sure to check your out-of-pocket maximum. If it’s $2,500, for example, after you meet your deductible you’ll have to pay a certain percentage of all your medical bills until they total $2,500, at which point the insurance company typically picks up 100 percent of future expenses. Different percentages have different out-of-pocket maximums. Remember, though, that your deductible and everything else typically starts back at zero at the beginning of each calendar year.
Ask yourself, “If I went to the hospital and paid $10,000 for a broken arm, how much would I have to pay total?” Apply the same question using three hypothetical levels of cost to discover which coinsurance and out-of-pocket maximum combination is the most affordable. For me, 50 percent coinsurance ends up being best because of a lower out-of-pocket maximum.
Co-pays: After calling my intended insurance agency with questions about the coinsurance and out-of-pocket maximum, I placed a call to a health insurance agent to ask about changing my plan to include co-pays. And she taught me something new: Doctors often negotiate rates with health insurance companies if you don’t have a co-pay. Which means it’s worth calling your doctor to see what the negotiated rate is before you increase your premium with the co-pay option.
Using the agent’s example of being discounted from nearly $120 to $75 for her own recent doctor’s visit, I discovered I would save more by visiting the doctor with the negotiated rate rather than changing my plan to include co-pays and increase my monthly premium.