Health Insurance Made Easy
● By Sandy Kauten
It’s important to remember that unless you experience a particular qualifying event, like getting married or divorced, having a baby, or moving to a new town, your next opportunity to enroll in health insurance won’t be until November 15, 2014, and your benefits won’t take effect until January 1, 2015. And, if you don’t enroll by April 30, you face a tax penalty of 1 percent of total income, with a minimum penalty of $95. Oregonians applying directly with private insurers in April may still face a partial federal tax penalty.
Shopping for health insurance can be an overwhelming experience, especially when you’re selecting a plan to meet the needs of your entire family, but doing a little homework before you start shopping can make the process less stressful. You don’t need to be an expert to find the right plan—you just need the right information.
Determine your health care needsEvery family has different health care needs and there isn’t a “one size fits all” insurance plan that works for everyone. The first step is to think about the health care needs of each member of your family and then anticipate those needs over the course of an entire year. While it’s impossible to know how your health will change over that year, you should be able to estimate how many regular visits you’ll make to the doctor, and any additional needs family members may have that would that require a visit to a specialist.
Have these questions answered before you begin searching for health plans:
- Does a family member have an ongoing condition that requires regular appointments and management?
- What types of prescription medications does your family need?
- How r?many preventative care doctor visits do you expect in the next year?
- Is anyone due to receive immunizations?
- Do you need or anticipate needing prenatal or maternity care?
- Does a family member participate in extreme activities prone to injury?
Once you’ve identified your needs, take a moment to determine your care preferences. Start by thinking about the relationship you want to have with your doctor. Some plans require member to see “in-network providers,” while others allow you to visit any doctor you choose. Health Republic, for example, partners with Providence Health Plan for use of its statewide provider network, which means we have an extensive network of providers, practitioners and facilities across Oregon. Some lesser expensive plans have limited or “narrow networks.” Additionally, not all plans cover all providers, such as chiropractors, naturopaths and adult vision services.
- Do you prefer a relationship with one primary care doctor?
- Does your family travel often?
- Does anyone in your family see specialists frequently?
- Do you use chiropractors, naturopaths or acupuncturists?
- Do you wear glasses or contact lenses?
Calculate your budget
Setting a monthly budget will help narrow your choices, but look beyond deductibles and premiums to determine which plan provides the most value. One important fact to remember: the lowest premium is not always the best value for you. In fact, low premium plans may cost you more money over the year than those that cost a little bit more each month.
Take the time to crunch the numbers—factor in premiums, deductibles, co-pays and the number of anticipated visits to the doctor. Consider the cost of co-pays and other expenses that can quickly add up.
Finally, use the online calculator at Cover Oregon to determine whether you qualify for health insurance subsidies and how much money they might save you. If you don’t need financial assistance, you can bypass the Cover Oregon exchange and enroll directly through a broker or health insurance provider to start your coverage sooner.
Cut through the jargon
Understanding how insurance works makes the shopping process much easier and empowers you to make the best decision for your family.
Here are some key terms worth knowing, with information from the glossary at healthcare.gov:
A fixed cost that you pay for a covered health care service that is covered by insurance, usually when you receive the service. The amount can vary by the type of covered health care service.CO-OP: Consumer Operated and Oriented Plan:
A nonprofit organization that offers competitive health plans in the individual and small group markets. All CO-OP income after expenses must be used to lower premium rates, improve benefits and improve quality. CO-OPs offer insurance directly to consumers and small businesses, as well as through the Cover Oregon exchange.
The amount you owe for health care services your health insurance covers before your health insurance begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Open Enrollment Period
The period of time when individuals who are eligible for a Qualified Health Plan can enroll in a plan through Cover Oregon. For 2014 coverage, Open Enrollment in Oregon ends on April 30th. The Open Enrollment Period for 2015 coverage runs from November 15, 2014 to February 15, 2015. Individuals may also qualify for special enrollment periods outside of open enrollment if they experience certain life events like getting married, having a child, or moving to a new town.
PremiumThe amount that you pay for your health insurance or plan. You and/or your employer usually pay the premium monthly, quarterly or yearly.
Qualified Health Plan
An insurance plan that is certified by the Oregon health insurance exchange, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements.
If you come across a term you don’t recognize, chances are there’s an explanation available from the glossary at healthcare.gov.
Dawn Bonder is CEO of Health Republic, a nonprofit CO-OP that offers health insurance coverage to the people of Oregon. She is the mother of three teenage sons.