8 Tips For Picking the Best Marketplace Health Plan

With millions of Americans losing their employer coverage, record numbers could be choosing a plan on the Marketplace for the first time. Unfortunately, without the right advice they will probably pick the wrong plan, costing them thousands of dollars and unknown health repercussions. Luckily, the experts at National Patient Advocate Foundation are here to help.

Rebecca Kirch, executive vice president of programs and policy, knows how often people get overwhelmed and rush the process. “Regardless of whether you are new to the Marketplace or have enrolled before, taking your time during open enrollment to evaluate your needs and choose the correct plan could save you thousands of dollars.”

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With open enrollment starting on November 1, Kirch advises that patients take the time to “do a health care audit” and critically evaluate their plans, their doctors and their treatment plans to make sure they are working for them. “Open enrollment is a good time to ask everything from whether you’re comfortable with your doctor to if you could switch to generics and save money on prescription drugs,” she noted.

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Other expert tips include:

1. Know the deadlines and don’t miss them. For instance, while open enrollment for the federally-run Marketplace begins on November 1st and closes on December 15^th, states that run their own Marketplaces may have extended deadlines. Buyer beware, though: if you buy a plan after the new year, your coverage will not begin for several weeks, if not months.
2. Consider all types of out-of-pocket spending. Most people tend to pick a plan based on the monthly premium, but that’s not enough to really understand what your costs will be. Equally important costs to consider are the deductible and your copays or coinsurance.
3. Unsure of a term? Find out before committing to a plan. People encounter plenty of unfamiliar words that are unique to health insurance – but not knowing what a term means could hurt your budget. If you don’t know what a term means, look it up using Patient Advocate Foundation’s Patient Healthcare Glossary.
4. Bronze may not be for you. Marketplace plans are tiered as Bronze, Silver, Gold and Platinum with increasing levels of coverage. While the Bronze plan will have the smallest monthly premium, the Silver plan may ultimately cover more of your costs.
5. Consider your subsidy first. Enter your annual household income on healthcare.gov before comparing plans to see premium rates personalized for you. You may also be eligible for assistance paying your out-of-pocket costs. Most people do receive financial assistance. Remember, too, that plans on the Marketplace may look more expensive at first, but they’re the only place you can use that federal subsidy.
6. Buy a comprehensive plan to avoid surprises. Short-term plans or health care sharing ministries may look like a good b******, but they often won’t cover you when you really need it, or require you to pay even more money upfront while you wait for reimbursement.
7. Stay in-network. Before committing to a plan for the year, make sure that your preferred providers will be in-network on that plan.
8. Review, review, review: Almost all insurance plans can change their benefit structure annually. Even if your plan stays the same, your own medical needs may change. Review your coverage every year to make sure that you are enrolled in the best plan for your needs.

“We know that choosing a plan can be daunting, but with the right tools and enough time, we’re confident people can make good choices,” said Kirch.

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