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Open Enrollment Is Here: 6 Tips For Choosing A Health Insurance Plan

HealthCare.gov provides tools to guide you cost comparisons when you're choosing a health care plan.
Catie Dull
HealthCare.gov provides tools to guide you cost comparisons when you're choosing a health care plan.

It's the season to roll up your sleeves, gather your documents, and pick a health insurance plan for 2020. For those shopping for their own plans, HealthCare.gov and the other state exchanges are open for enrollment as of November 1.

Despite the rhetoric about the implosion of the Affordable Care Act, the individual mandate going away, and other attempts to hobble the law, the marketplaces are still alive and well. And many people are eligible for subsidies to bring their costs down.

In fact, HealthCare.gov has gotten sleeker and easier to use over the years (after a famously rocky start). There are new bells and whistles to make shopping for a plan easier this year. Still, figuring out how to balance premiums, deductibles and other costs, and choose a plan that will fit your needs for the coming year is hard.

Charlene Wong knows this from experience. Even as a doctor and academic at Duke University who studies how people make health insurance choices, a few years ago, she and her husband picked the wrong plan.

"We spent several days researching plans and called around to make sure the doctors we wanted to see were in network," she says. Then she got pregnant, and found that while her OB was in network, there was a catch.

"There was a tiered network within that health insurance plan and [my OB] was in Tier 3 of network providers," she explains. Even though she thought she'd done everything right, she ended up having to switch doctors to keep her costs down.

So take heart — health insurance can be tricky, even for the experts. Here are a few tips to help you find the right plan.

1 - Figure out where and when you need to enroll

Depending where you live, you can either use the federal exchanges on HealthCare.gov or your state's marketplace to shop for insurance. Twelve states and the District of Columbia run their own exchanges. The federal exchange open enrollment runs until mid-December, but you might have more time if you live in a state that runs its own marketplace.

2 - Review plan options, even if you like your current one

For people who are already enrolled in an ACA plan, Charles Gaba says it's really important to log in and check if there's a better value, even if you're happy with your current plan. Gaba runs the website ACAsignups.net, where he does health care data and policy analysis, focused primarily on the Affordable Care Act.

It can be tempting to skip the whole enrollment rigmarole, especially since you'll just get rolled into the same plan or a similar plan if you do nothing during open enrollment.

"A lot of people think that because nothing changed in their lives — like, their income is the same, the same household — nothing will change for their policy or their premiums, and that's just not true," Gaba says.

Every year, there can be all sorts of changes that affect the kinds of plans available and the costs of those plans. For instance, this year new insurers have entered the marketplace, and premiums have gone down in some states. It's always worth logging in and checking to see what's changed for you and whether it makes sense to switch things up.

3 - Compare estimated yearly costs, not just monthly premiums

It's easy to focus on the monthly premium payment when comparing plans, but Wong at Duke says don't forget to consider other costs as well.

"A lot of people — we know from past research — become overly focused on the monthly premium and may not pay as much attention to things like the deductible or how much the co-payments are," Wong says.

The premium price is prominently featured when you're looking at plans, but look at other costs too. A tool available on HealthCare.gov and some state marketplaces will calculate "estimated total yearly costs" for you. This takes into account the plan's deductible — how much you have to pay out-of-pocket for covered services before your insurance picks up the tab — and copays, put together with how much health care you expect to use in the coming year.

Wong says that yearly cost estimate can be a really useful tool when picking a plan. "Trying to figure out that math can be a little bit tricky, especially for people who are not as familiar with health insurance." she says.

4 - Consider how much health care you use

Picking the right insurance plan involves guesswork about how many health issues you're likely to face in the coming year, which could affect the way costs break down. Your age is usually a useful proxy for this, but there's always a lot of unknowns, like a surprise cancer diagnosis or a car accident.

Wong points out there are basic tradeoffs to consider. "You might want to think about, 'Do I pay a little bit more each month in a monthly premium knowing that that would mean less out-of-pocket expenses when and if I do need more medical care?" she says. "Versus — the other way around — 'Let me pay a lower monthly premium because I don't really anticipate needing much care, but I know I'd have this health insurance in case something really catastrophic happens.' "

Alongside these unknowns, leverage what you do know about your health needs. If you have a doctor you like, or if you know you're going to take a certain prescription drug, look for a plan that covers them. HealthCare.gov allows you to add your provider and your prescription drugs as you browse plans to see whether they're covered. Another way to find out is simply call your doctors and ask what plans they accept, says Wong.

5 - Beware too-good-to-be-true plans

If you see a good deal online, make sure you're looking at an ACA plan, warns health policy writer and insurance broker Louise Norris. When you search for health insurance on the internet, you may stumble on short term plans that advertise much lower monthly premiums, but don't cover the ACA's famous ten essential benefits. These include some pretty important stuff like prenatal care and mental health treatment.

Sometimes people can find good deals on premiums in the federal and state marketplaces, Norris says, but if one plan sticks out as being too good to be true, read the fine print.

"I did see some new plans popping up in some areas for 2020 where they'll say $0 deductible," she says. "Then you scroll down a little bit further and you have maybe $1,000 a day copay for hospitalization." You hope you won't spend a lot of time in the hospital, but if you do, that kind of cost could really add up.

Norris points out a new tool this year to help sort out good plans from bad — a star rating, similar to what consumers are used to on Yelp or Amazon (hearkening back to Obama's original vision). The star ratings are based on information insurers submitted regarding cost, combined with enrollee feedback.

"Star ratings are one of those at-a-glance things where you can kind of see, "OK, how do other customers feel about this plan?' " Norris says. Not all plans have them since some are new, she says, but for plans that do, the stars "give you some some red flags if maybe there are some concerns."

6 - Get free help from the pros

The Trump administration slashed federal funding for advertising open enrollment and the navigator program, but those programs do still exist: There are still people across the country trained and ready to sign people up — for free.

"My best piece of advice for people — particularly those who are less familiar with insurance, is to see if you can get some help," Wong says. You can call for help, but she recommends trying to meet in person with "a health insurance navigator or a certified application counselor," she says. "Importantly, these are folks who are impartial to which health insurance plan may be best for you."

Katie Turner is one of those trained navigators — she's been signing people up for seven years, and works with the Family Health Care Foundation in the Tampa Bay, Fla., area. Leading up to open enrollment, she's been busy calling consumers from past years, letting them know that this is the time.

She advises people to assemble all the necessary documents, such as Social Security cards, immigration documentation, tax returns, before going into a meeting with a navigator.

Most of all, she says, don't miss your chance to sign up for coverage if you need it.

"There is a lot of confusion out there," Turner says. Many people are confused about what a legal challenge to the law means for the marketplaces (nothing for now), when open enrollment is, and more. "All we can do," Turner says, "is continue to be here and provide the resources that we've been providing for the last seven years to help people enroll in coverage."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Selena Simmons-Duffin reports on health policy for NPR.
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