10 Nov Health Insurance & Open Enrollment: What You Need to Know
We know that health insurance can be overwhelming and stressful. But it doesn’t have to be. The Patient Protection and Affordable Care Act (ACA) includes changes to make it easier to shop for, and purchase, insurance.
As we approach the second open enrollment period (November 15, 2014, through February 15, 2015) to buy insurance coverage through the state Health Insurance Marketplaces created by the ACA, here are a few tips to help you navigate health insurance.
- Make sure you understand common health insurance terms. Don’t be embarrassed if you’ve heard these terms a lot, but still don’t totally understand them or how they all work together. Here are a few critical ones:
- Premium: the amount you pay monthly just to have health insurance
- Deductible: the amount you have to pay each year before the health insurance policy starts paying for your medical expenses
- Co-Pay: an amount you may have to pay each time you access certain health care services (e.g., $25 when you see the doctor, or $10 for each prescription drug)
- Cost-share: the difference between what your health insurance policy pays and what you pay for your medical expenses (e.g., 80/20 plans are ones where you are responsible for 20% of your health care costs and the plan is responsible for 80%, after you meet your deductible)
- Out-of-Pocket Maximum: the most you are responsible for paying for covered medical care each year. The deductible plus any co-pays or cost-share amounts that you pay add up to help you reach out of pocket maximum. Once you reach that amount, your insurance should pay for 100% of your covered medical expenses.
- Keep an eye out for hidden costs as you shop for new insurance. For example, if you are in the midst of treatment, a Bronze level plan (60/40 cost share) is likely not going to be appropriate. And pay attention to whether or not plans have separate deductibles for medical services and prescription drugs.
- Learn about what is actually included in the ACA and how the law may potentially benefit you. One resource would be Triage Cancer’s Quick Guide to the ACA, available for free at: http://triagecancer.org/health-care-reform.
- Look into possible financial assistance options available to you.
- If you are purchasing health insurance through the Marketplaces, you may be eligible for premium tax credits and/or cost-sharing subsidies. These financial assistance options are based on family size and income level.
- If you are having trouble paying their co-pays, you may be eligible for programs like the Patient Advocate Foundation’s Co-Payment Relief program and CancerCare’s Co-Payment Assistance Program.
- Programs like NeedyMeds and RxHope may be of assistance if you are having trouble paying for your prescription drugs. Additionally, you may be able to find assistance through the pharmaceutical company that makes the drugs they are taking.
- Know that that there are places to go for more help when trying to navigate health insurance:
- General information about the ACA and health insurance can be accessed for free at http://TriageCancer.org/Resources, or through one of Triage Cancer’s free webinars.
- If you are shopping for insurance in the Health Insurance Marketplaces there are likely in-person assistors that you can contact in your community: https://localhelp.healthcare.gov or call 800.318.2596.