This article may contain affiliate links. When you click these links and make a purchase, I may get a small commission. It won’t cost you anything, but it helps me to run this site.
Health insurance is too complicated
Trying to program the clock on my coffee pot sometimes makes me wonder how I’ve kept the dog alive this long. Being a productive member of society (adult) does not correlate to understanding health insurance.
I’m going to show you how to get from a point of little understanding to a clearly identified set of priorities with your insurance in a few steps.
Gaining a basic understanding of the working parts of health insurance plans will get you to a place of more confidence when choosing a plan from year to year.
Get a head start and download my health plan checkup worksheet here.
Finding health insurance is easier than you think
If you have always had health insurance through your workplace and that is no longer an option it may seem overwhelming to find health insurance on your own.
There are many options available. Starting with healthcare.gov, where you can view marketplace plans or be redirected to state specific websites and see if you qualify for premium tax credits or cost sharing reductions. This site can be searched and reviewed on your own or with the help of navigators.
Insurance agents and brokers are able to help you find a health insurance plan as well. You can search for an agent or broker near you and call to make an appointment. Where healthcare.gov will only show you “qualified health plans” that meet all ACA requirements. Agents and brokers will have access to search private health insurance plans that may not meet all ACA requirements but meet everything you need for your health right now.
For people with low income that are not able to afford insurance premiums, medicaid may be an option. Medicaid qualification is different in each state with income, disability, household size and family status being factors. Some states have expanded medicaid up to 133% poverty level and based solely on income.
Get a head start and pick up my health plan checkup worksheet here
Healthcare services are available without traditional insurance
The share of privately insured adults with deductibles of $1,000 or more has doubled since 2010. The average premium for single coverage has increased 4% since 2018. If you can no longer afford premiums and deductibles don’t give up on receiving medical care.
Indemnity plans are becoming increasingly popular because you pay smaller premiums but don’t have the same coverage as an ACA qualified health plan. Where you have preventive visits covered under a marketplace or ACA qualified health plan, you would not have those covered under an indemnity plan. However, you have more control over the amount you spend at a provider and which provider you see based on cost. There is an opportunity here for comparison shopping based on prices and reviews.
Health sharing plans are also an option for people looking to move away from traditional insurance. These plans typically have you pay your share, similar to a premium but not as high, and that amount is used to pay someone else’s medical bill. If needed, you submit your medical bill to the plan to have others pay towards it as well, sharing the burden.
Federally Qualified Health Clinics (FQHC) and big box stores that offer health clinics are another way to seek care without the higher cost of monthly premiums. FQHCs and public health clinics charge based on income, reducing your out-of-pocket costs. Department stores have health clinics in some cities that offer services at set rates. Lack of insurance would not prevent you from receiving service from any of these locations.
I’m stuck having high premiums
One of the easiest ways to reduce your premium cost is to increase your deductible. If you are using your health insurance for prescriptions, two physician visits a year and lab work you may consider a different type of plan. Having a High Deductible Health Plan will reduce your premiums and may allow you to put money aside in a Healthcare Spending Account (HSA). No one says you can’t use the service options provided above and pay out of pocket for service if it is cheaper than using your insurance.
Get a hard start and pick up my health plan checkup worksheet here.
You’re doing this
Letting other people make decisions for you. I felt like I had to completely understand health insurance before I could make a decision on my own. I didn’t trust myself to have the right answers.
Trusting someone else to know you better than you know yourself. I let someone else tell me what was working for them and I went with that option instead.
Waiting until the last minute and then not making a decision. I tried ignoring the whole thing and letting the plan from the year before roll over into the next year. That didn’t work either because my situation had changed so drastically that my insurance coverage no longer met my needs and I was paying through my teeth for basics.
But you want this
To walk into an appointment and know exactly how much you owe for the visit and have the money to pay up front. Finally feeling like an adult.
To schedule surgery and know exactly how much you will owe and how you’ll pay off the balance without using credit cards or feeling out of control.
To have complete confidence and control that comes with knowing exactly what you need and how much you can afford without the guesswork.
Get a head start and pick up my health plan checkup worksheet here.
You can…
Search for health insurance as easily as you program Spotify to your moods.
Effortlessly shop for health services with or without insurance.
Make annual visits a priority to catch problems before they require medication.
But let’s be honest.
You don’t want someone to talk down to you because you are educated and have the student loans to prove it.
You can google anything you need or find it on YouTube so why bother?
You can call your insurance provider while at the doctor’s office…with your kids…to find out how much it will cost.
I felt that way too. And after helping other women work through this I discovered….
You ARE BUSY.
Your time is money and your money has goals. Like that house you dream of moving into one day.
You need the answer to your question without having to filter through 18 google pages.
You know in your heart that you need to understand this to help your family.
But you’ve probably put it off because you think this is as good as it gets. Does this look familiar?
You may not consider yourself underinsured but have you experienced difficulty paying for medical expenses (prescriptions) or delayed getting needed care?
“Even before the pandemic, people were struggling with inadequate health coverage and mounting medical debt. It has never been more important to ensure that all U.S. residents have affordable, comprehensive coverage to survive this pandemic and beyond, “ said David Blumenthal, M.D., president, The Commonwealth Fund, in a recent announcement about the Biennial Health Insurance survey.
I have cried while begging my insurance company to find a prescription that works as well but costs less because I couldn’t afford my $75 copay each month. I have also skipped medical tests because there was no way I could pay “my portion” of the cost.
After my third surgery in three years and mounting medical debt I began to research the healthcare system in the U.S. and what I needed to do to make life easier and less complicated. I discovered it doesn’t have to be so difficult but we have to face open enrollment head on and be willing to ask questions.
I still have above average use of my health insurance plan each year and I haven’t been caught off guard by unexpected medical billing since 2005.
Amazeballs right?
The best part is, you can start today. You don’t need a background in finance or healthcare administration to makeover your health insurance plan.
Where to start?
Have a willingness to dive in and learn something new.
You already know that health insurance and all of its moving parts is complicated. Believe in yourself and your ability to understand this stuff.
Let’s Dive In
Review your current plan
Before you can make changes to your health insurance for the new plan year, you need to fully understand what isn’t working with the plan you have right now.
If your health insurance plan has a website, login and review the claims that have been paid out this year.
Did you receive bills that were unexpected during the year? If so, look up those specific claims and see how much was paid by insurance.
What about your current health insurance plan do you like? Write these items down. Also, write out a list of things you do NOT like about your plan. This will help you compare new plans against your current plan.
You can use my health plan checkup worksheet to help you with these steps. Get it here.
Determine what is most important
Health insurance is made up of multiple parts. The premium is the money you pay each month to have insurance. Do you need this to stay the same, be reduced or can it go higher?
Your deductible is the amount of money you must pay first before your insurance pays out. For example, if you have hospital coverage but you have a $7,500 deductible your insurance may pay 80% of all bills AFTER you have paid $7,500 for the plan year. If you have a High Deductible Health Plan you may be required to reach your deductible before insurance will pay towards prescription medications as well. Looking at your current plan, do you need the deductible to stay the same, be reduced, or can it be higher?
The maximum out-of-pocket cost is the amount that you should not exceed paying during your plan year for covered services. Out-of-pocket limits do not include anything you spend on services not covered, out-of-network care and services, and costs above the allowed amount for a service. You may never reach the maximum out-of-pocket limit during a year but this is helpful to review in case of catastrophic events. Marketplace plans have set limits for maximum out-of-pocket amounts. For example, 2021 plans have a maximum out-of-pocket of $8,550 for an individual and $17,100 for a family. Looking at your current plan, do you need the maximum out-of-pocket to stay the same, be reduced, or can it be higher?
While reviewing your premium, deductible and maximum out-of-pocket costs for your current plan year determine which is the most important to you. Do you want to pay less out each month or less overall?
Could you be paying less
Once you have looked closely at premiums, deductibles, and max out-of-pocket costs you can dive deeper into what you pay at each visit.
Copays or coinsurance might be relatively low but how often are using them? If you make one doctor visit a year and it is for an annual screening that is covered free of charge you may not be worried about expensive copays. However, if you see three specialists twice a year at $55 for each visit you may want to take a closer look at copay or coinsurance options on new plans.
When reviewing plans with coinsurance options instead of set amounts for doctor visits make sure you are also researching the cost of the visit in your area. Visit https://www.healthcarebluebook.com/ to compare medical expenses in your zip code. If you find a plan that has a 20% coinsurance for an office visit you need to know if the office visit is $119 or $363 for planning purposes.
Is the money worth the hassle
You have to decide if you like your current doctors enough for the hoops. If you change health insurance plans there will be hoops to jump through to see if your current doctors are in-network on the new plan.
This can be done multiple ways. You can call your doctor’s office and ask if they accept the new insurance. You can also do a physician lookup with most health plans before purchasing. Doing this before purchasing a new health plan will save you time and headaches if you do have to change physicians. Knowing that you will have to change to a new doctor allows you to look at the amount you are paying and the added work to find a doctor and decide if saving the money is worth the hassle to you.
Grab my health plan checkup worksheet to help yourself work through these steps. Get it here.
So you want affordable health insurance?
This can be the year you make that happen but first you have to decide which is most important to you; your monthly expenses (premiums, copays, prescriptions) or your total cost.
If you aren’t satisfied with a high deductible be absolutely clear on how much you spend in a typical year on medical expenses. It is possible you would be spending more on high premiums and low deductibles than you would if you paid full price for the medical care you are using.
If you are committed to taking a close look at your medical expenses then you can find lower costs.
Not ready to figure out your expenses and cut your costs?
Diving into your healthcare expenses from this year and last year to get clear on where you are spending is not easy. It is time consuming and requires finding paperwork or resetting passwords to login to your account.
Tackling my health insurance saved me so much money and heartburn because I was able to completely cut down on unexpected medical billing and gain confidence.
You don’t have to figure out everything to move forward. Grab my guide to network providers and learn which type of network is best for you.
Just imagine a year from now
Reviewing your expenses for the past year and feeling proud because you didn’t pay for more than you needed.
Debt is paid down from the money you’ve saved.
You are confident about giving advice to a friend because they continue to be surprised by medical expenses.
You no longer worry about healthcare at all. Now, you are clear on what you need and how to maximize your plan.
And you get the chance to sit back, take a deep breath and savor the milestone. Everything just feels a little lighter and a little easier.
Yours in health,
Hayla
Get started with my health plan checkup worksheet. Get it here.
