{"id":29187,"date":"2023-10-24T17:26:44","date_gmt":"2023-10-24T17:26:44","guid":{"rendered":"https:\/\/microloannexus.com\/news\/picking-health-insurance-can-be-tricky-6-key-terms-to-know-as-open-enrollment-starts\/"},"modified":"2023-10-24T17:26:45","modified_gmt":"2023-10-24T17:26:45","slug":"picking-health-insurance-can-be-tricky-6-key-terms-to-know-as-open-enrollment-starts","status":"publish","type":"post","link":"https:\/\/microloannexus.com\/?p=29187","title":{"rendered":"Picking health insurance can be tricky: 6 key terms to know as open enrollment starts"},"content":{"rendered":"
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Many people will soon be picking their health insurance plans for 2024: November is a common month for workplace open enrollment, and the public marketplace opens Nov. 1.<\/p>\n

But choosing a health plan can be tricky.<\/p>\n

In fact, a 2017 study found many people lose money due to suboptimal choices: Sixty-one percent chose the wrong plan, costing them an average $372 a year. The paper, authored by economists at Carnegie Mellon University and the Wisconsin School of Business, examined choices made by almost 24,000 workers at a U.S. firm.<\/p>\n

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Health plans have many moving parts, like premiums and deductibles. Each has financial implications for buyers.<\/p>\n

“It is confusing, and people have no idea how much they could potentially have to pay,” Carolyn McClanahan, a certified financial planner and founder of Life Planning Partners, based in Jacksonville, Florida, previously told CNBC. McClanahan is also a medical doctor and a member of CNBC’s FA Council.<\/p>\n

Making a mistake can be costly; consumers are generally locked into their health insurance for a year, with limited exception.<\/p>\n

Here’s a guide to the major cost components of health insurance and how they may impact your bill.<\/p>\n<\/div>\n

1. Premiums<\/h2>\n
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The premium is the sum you pay an insurer each month to participate in a health plan.<\/p>\n

It’s perhaps the most transparent and easy-to-understand cost component of a health plan \u2014 the equivalent of a sticker price.<\/p>\n

The average premium paid by an individual worker was $1,401 a year \u2014 or about $117 a month \u2014 in 2023, according to a survey on employer-sponsored health coverage from the Kaiser Family Foundation, a nonprofit. Families paid $6,575\u00a0a year, or $548 a month, on average.<\/p>\n

Your monthly payment may be higher or lower depending on the type of plan you choose, the size of your employer, your geography and other factors.<\/p>\n<\/div>\n

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Low premiums don’t necessarily translate to good value. You may be on the hook for a big bill later if you see a doctor or pay for a procedure, depending on the plan.<\/p>\n

“When you’re shopping for health insurance, people naturally shop like they do for most products \u2014 by the price,” Karen Pollitz, co-director of KFF’s program on patient and consumer protection, previously told CNBC.<\/p>\n

“If you’re shopping for tennis shoes or rice, you know what you’re getting” for the price, she said. “But people really should not just price shop, because health insurance is not a commodity.<\/p>\n

“The plans can be quite different” from each other, she added.<\/p>\n<\/div>\n

2. Co-pay<\/h2>\n
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Many workers also owe a copayment \u2014 a flat-dollar fee \u2014 when they visit a doctor. A “co-pay” is a form of cost-sharing with health insurers.<\/p>\n

The average patient pays $26 for each visit to a primary-care doctor and $44 to visit a specialty care physician, according to KFF.<\/p>\n<\/div>\n

3. Co-insurance<\/h2>\n
\n

Patients may owe additional cost-sharing like co-insurance, a percentage of health costs that the consumer shares with the insurer. This cost-sharing generally kicks in after you’ve paid your annual deductible (a concept explained more fully below).<\/p>\n

The average co-insurance rate for consumers is 19% for primary care and 20% for specialty care, according to KFF data. (The insurer would pay the other 81% and 80% of the bill, respectively.)<\/p>\n

As an example: If a specialty service costs $1,000, the average patient would pay 20% \u2014 or $200 \u2014 and the insurer would pay the remainder.<\/p>\n

Co-pays and co-insurance may vary by service, with separate classifications for office visits, hospitalizations or prescription drugs, according to KFF. Rates and coverage may also differ for in-network and out-of-network providers.<\/p>\n<\/div>\n

4. Deductible<\/h2>\n
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Deductibles are another common form of cost-sharing.<\/p>\n

This is the annual sum a consumer must pay out of pocket before the health insurer starts to pay for services.<\/p>\n

Ninety percent of workers with single coverage have a deductible in 2023, according to KFF. Their average general annual deductible is $1,735.<\/p>\n

The deductible meshes with other forms of cost-sharing.<\/p>\n

Here’s an example based on a $1,000 hospital charge. A patient with a $500 deductible pays the first $500 out of pocket. This patient also has 20% co-insurance, and therefore pays another $100 (or, 20% of the remaining $500 tab). This person would pay a total $600 out of pocket for this hospital visit.<\/p>\n<\/div>\n

\n
\n
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When you’re shopping for health insurance, people naturally shop like they do for most products \u2014 by the price.<\/p>\n

\n

Karen Pollitz<\/p>\n

co-director of the program on patient and consumer protections at the Kaiser Family Foundation<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/blockquote>\n

\n

Health plans may have more than one deductible \u2014 perhaps one for general medical care and another for pharmacy benefits, for example, Pollitz said.<\/p>\n

Family plans may also assess deductibles in two ways: by combining the aggregate annual out-of-pocket costs of all family members, and\/or by subjecting each family member to a separate annual deductible before the plan covers costs for that member.<\/p>\n

The average deductible can vary widely by plan type: $1,281 in a preferred provider organization (PPO) plan; $1,200 in a health maintenance organization (HMO) plan; $1,783 in a point of service (POS) plan; and $2,611 in a high-deductible health plan, according to KFF data on single coverage. (Details of plan types are in more detail below.)<\/p>\n<\/div>\n

5. Out-of-pocket maximum<\/h2>\n
\n

Most people also have an “out-of-pocket maximum.”<\/p>\n

This is a limit on the total cost sharing consumers pay during the year \u2014 including co-pays, co-insurance and deductibles.<\/p>\n

“The insurer can’t ask you for a co-pay at the doctor or pharmacy, or hit you for more deductibles,” Pollitz said. “That’s it; you’ve given your pound of flesh.”<\/p>\n

About 99% of workers with single coverage are in a plan with an out-of-pocket maximum in 2023, according to KFF.<\/p>\n

The range can be large. For example, 13% of workers with single coverage have an out-of-pocket maximum of less than $2,000, but 21% have one of $6,000 or more, according to KFF data.<\/p>\n

Out-of-pocket maximums for health plans purchased through an Affordable Care Act marketplace can’t exceed $9,100 for individuals or $18,200 for a family in 2023.<\/p>\n<\/div>\n

6. Network<\/h2>\n
\n

Health insurers treat services and costs differently based on their “network.”<\/p>\n

“In-network” refers to doctors and other health providers that are part of an insurer’s preferred network. Insurers sign contracts and negotiate prices with these in-network providers. This isn’t the case for “out-of-network” providers.<\/p>\n

Here’s why that matters: Deductibles and out-of-pocket maximums are much higher when consumers seek care outside their insurer’s network \u2014 generally about double the in-network amount, McClanahan said.<\/p>\n

Further, there’s sometimes no cap at all on annual costs for out-of-network care.<\/p>\n

“Health insurance really is all about the network,” Pollitz said.<\/p>\n

“Your financial liability for going out of network can be really quite dramatic,” she added. “It can expose you to some serious medical bills.”<\/p>\n<\/div>\n

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Some categories of plans disallow coverage for out-of-network services, with limited exception.<\/p>\n

For example, HMO plans are among the cheapest types of insurance, according to Aetna. Among the tradeoffs: The plans require consumers to pick in-network doctors and require referrals from a primary care physician before seeing a specialist.<\/p>\n

Similarly, EPO plans also require in-network services for insurance coverage, but generally come with more choice than HMOs.<\/p>\n

POS plans require referrals for a specialist visit but allow for some out-of-network coverage. PPO plans generally carry higher premiums but have more flexibility, allowing for out-of-network and specialist visits without a referral. \u00a0<\/p>\n

“Cheaper plans have skinnier networks,” McClanahan said. “If you don’t like the doctors, you may not get a good choice and have to go out of network.”<\/p>\n<\/div>\n

How to bundle it all together<\/h2>\n
\n

Budget is among the most important considerations, Winnie Sun, co-founder and managing director of Sun Group Wealth Partners in Irvine, California, previously told CNBC. She’s also a member of CNBC’s FA Council.<\/p>\n

For example, would you struggle to pay a $1,000 medical bill if you require health care? If so, a health plan with a larger monthly premium and a smaller deductible may be your best bet, Sun said.<\/p>\n

Similarly, older Americans or those who require a lot of health care each year \u2014 or who expect to have a costly procedure in the coming year \u2014 may do well to pick a plan with a bigger monthly premium but better cost-sharing.<\/p>\n

Healthy people who generally don’t max out their health spending every year may find it cheaper overall to have a high-deductible plan, McClanahan said.<\/p>\n<\/div>\n

\n
\n
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Cheaper plans have skinnier networks. If you don’t like the doctors, you may not get a good choice and have to go out of network.<\/p>\n

\n

Carolyn McClanahan<\/p>\n

certified financial planner and founder of Life Planning Partners<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/blockquote>\n

\n

Consumers who enroll in a high-deductible plan should use their monthly savings on premiums to fund a health savings account, advisors said. HSAs are available to consumers who enroll in a high-deductible plan.<\/p>\n

“Understand the first dollars and the potential last dollars when picking your insurance,” McClanahan said, referring to upfront premiums and back-end cost-sharing.<\/p>\n

Every health plan has a “summary of benefits and coverage,” which presents key cost-sharing information and plan details uniformly across all health insurance, Pollitz said.<\/p>\n

“I’d urge people to spend a little time with the SBC,” she said. “Don’t wait until an hour before the deadline to take a look. The stakes are high.”<\/p>\n

Further, if you’re currently using a doctor or network of providers you like, ensure those providers are covered under your new insurance plan if you intend to switch, McClanahan said. You can consult an insurer’s in-network online directory or call your doctor or provider to ask if they accept your new insurance.<\/p>\n

The same rationale goes for prescription drugs, Sun said: Would the cost of your current prescriptions change under a new health plan?<\/p>\n<\/div>\n<\/div>\n

Read the full article here<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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