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Everything You Need To Know To Get The Best Health Insurance Coverage For You And Your Family

To navigate this confusing world of health insurance options,Preventionand the University of California, Los Angeles, teamed up on a survey—thePrevention/UCLA Center for Health Policy Research Survey—of more than 400 men and women ages 45 to 64, all of whom have health insurance coverage, to find out how people feel about the plans they have and how they feel the coverage is helping them and their families to stay healthy. You can compare your own situation with the survey responses to get an idea of how your plan stacks up. If you find your coverage doesn't compare well to other plans, we'll take you through the steps of finding a new policy that will.

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Even if you decide it's all too much of a hassle and you'd rather just stay with the plan you have, be prepared to find out that it may not be available anymore: In many locations, insurers such as Aetna and UnitedHealth Group are pulling out of the government's Health Insurance Marketplace, which offers health insurance for people who don't have coverage through a job, Medicare, Medicaid, or other sources. Insurance benefits from employers are changing, too: Nearly 30% now have high-deductible plans, compared with 20% just 2 years ago. "The days of comprehensive insurance with little or no out-of-pocket spending are over, so people need to be vigilant about shopping around for insurance to get the best value," says Gerald Kominski, director of the UCLA Center for Health Policy Research.

Your family's health insurance plan can make the difference between excellent medical care and substandard or no care, and between protecting your life savings and owing it to hospitals and other providers. Consider the contrasts between these two examples:

  • Allison Grossmanof Tampa pays premiums of ,000 a month for health insurance for her family of four. "Plus, we've spent ,500 on medical bills so far this year," she says. "My family's health care costs are nearly a quarter of our income before taxes. My husband is putting off shoulder surgery because we can't afford it."
     
  • Paul Prestifilippoof Wake Forest, NC, originally chose the least expensive plan his employer offered, but it made him nervous because, with three kids nearing college age, he didn't want to be hit with a giant, unexpected medical bill. Preferring to pay higher premiums and spread the costs more evenly throughout the year, he upgraded to a plan with a ,000 out-of-pocket max. "A few months later my wife, Jennifer, had a heart attack at age 47. Her hospital bill was ,000," he says. "But I only had to pay ,000 of it."
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It's tempting to choose the plan with the lowest premium and just be done with it, but that could be a big mistake, says Kominski. Plans with lower premiums usually have high deductibles and coinsurance, leaving you to shell out a lot of money for any care you need. Your own and your family's income and health status will help determine what's best. The stakes are high. In just the first 9 months of this year, 1 in 10 insured 45-to 64-year-olds spent more than ,000 on medical bills, according to our survey. "I can't imagine how some people would deal with such a large, unexpected expense," says Kominski. "That figure doesn't even include their monthly premiums." In fact, 30% of survey respondents pay more each month for health care—including insurance premiums and out-of-pocket costs—than they do for rent or a mortgage. And almost 1 in 5 have delayed seeking treatment or filling a prescription because their deductibles are high. The following expert advice, and responses from the survey, will take you through the steps of finding the right plan for staying healthy and debt-free.

So Many Choices. . .Or So Few?

If you get health insurance through your employer or your spouse's employer—as 71% of our survey respondents do—you probably have only a couple of options. That makes choosing easier, but know that you'll probably be paying about 6% more on average than you did last year, according to a survey by the National Business Group on Health.

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But if you're among the more than 1 in 4 who may be shopping on the Health Insurance Marketplace, you'll have to do some searching. The first step is to find out if you qualify for a subsidy for any of the available plans; the government will apply the subsidy directly to your monthly premium. The amount is based on the number of people in your family and your income (healthcare.govhas the details).

Regardless of what you've heard about "Obamacare," millions of people are now insured and happy with their coverage. "I left my office job last year to pursue an acting career," says Terry Kaye, 45, of Los Angeles. "I found a plan on the Marketplace that costs me 7 per month and covers the prescriptions I take. I'm happy with it."

If you don't qualify for a subsidy on the Marketplace, you can choose any plan offered there, but you might be in for sticker shock. Double-digit price increases are forecast for many states. Or you can look into buying a plan directly from a health insurance company; visit finder.healthcare.gov to look for options.

MORE: The 10 Most Painful Conditions

It's All About Networking

Now that you have a few plans you might be interested in, check each one to see if your favorite doctors and/or hospital participate in the plans' networks. If they don't, you might not be covered at all (in the case of an HMO plan) or you might be covered at a reduced rate (typically with a PPO plan) when in their care. In addition, if you take a brand-name medication regularly, find out if it's on the insurer's formulary, a list of prescription drugs covered by the plan. Otherwise, you might have to switch brands for coverage. "In our area, insurers cover different brands of steroid inhalers," says Charlene Wong, an adolescent medicine specialist in Philadelphia.

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Ignoring the network can have devastating consequences. UCLA's Kominski recounts that one of his colleagues received a ,000 bill from the surgeon who performed his emergency appendectomy. "Although the hospital where he received treatment was part of his health plan's network, the surgeon wasn't," Kominski explains. "And even though my colleague didn't have a choice in the surgeon, he was expected to cover the bill. He had to get our employer to intervene, and it still took 4 months to get it resolved." (Make sure you know these 14 secrets every health insurance company knows.)

Are You A Low, Medium, Or High Health Care User?

Now it's time to make the decision about whether to save money with low premiums but receive less coverage or pay high premiums knowing that you'll spend less out of pocket in case of illness. Think about how many health care services you and the family members on your plan have used in the past couple of years. You're classified as a low user if your care was limited to checkups, preventive tests, and just a few sick visits to primary care doctors. Add in a few visits to specialists and a couple of trips to the ER, and now you're a medium user. And if you or anyone in your family is receiving treatment for a health condition such as cancer or heart disease, your health care usage is high. Don't just look back a few years, but see if you can look forward, too. Consider whether something next year might change your health care usage—perhaps your teen is on a sports team, increasing the risk of injury, or you suspect that you might need knee replacement surgery.

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Experts recommend that if your usage is low and you have enough money saved to cover a high deductible plus a little extra cushion, it's probably safe to go with the lowest-premium plan. Establish a Health Savings Account if your plan qualifies, and you can use the tax-deductible dollars to pay toward the deductible. But if your usage is or will be high, choose a plan with a lower deductible and higher premiums, provided you can afford it.

In the middle? If your usage is medium, you need to dig deeper. The plan that will give you the most bang for your buck depends on more details—like the cost of seeing a specialist or ER copays. "It would be wonderful to have an app to help you with the decisions, but unfortunately one doesn't exist for consumers yet," says Eric Johnson, codirector of the Center for Decision Sciences at Columbia Business School.

MORE: 10 Silent Signals You're Way Too Stressed

Think About Health, Not Just Illness

Nearly half of the respondents in thePrevention/UCLA Center for Health Policy Research Survey said that they believed their health insurance plan is responsible for making them healthier because preventive exams are free. No matter what health insurance plan you have, preventive exams shouldn't cost you a dime. Nearly all insurance plans are legally obligated to foot the entire bill not only for exams, but also for a slew of screenings like mammograms, PSA tests, colonoscopies, vaccines, and even some programs that help you quit smoking or lose weight.






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Date: 10.12.2018, 12:36 / Views: 52473