This is Quantum’s “Cheat Sheet” for How to Avoid Problems with Health Benefits as much as humanly possible…
1. Any time you plan to see a doctor, look up whether he or she is in-network on your plan. You can do this by calling the # on the back of your insurance card or going online through your carrier’s provider finder & doing a search. Do NOT ask your doctor if he or she ‘takes’ your insurance. They will say ‘yes’ and this is misleading. See #2 for why.
2. Learn the difference between someone ‘taking’ your insurance and someone being ‘in-network’. Benefits today are only good if you stay in-network. Out-of-network there is no limit to what a service will cost, and insurance will typically cover 20% at best. When someone says they ‘take’ your insurance, it means they accept it on an out-of-network basis. This = getting screwed. If someone is truly in-network on your plan, they will know it, and they will tell you they are in-network or ‘contracted with’ your specific carrier.
3. Make sure to update your insurance info with your providers any time you receive new ID cards. This includes at the pharmacy.
4. Don’t use CVS for pharmacy services. They make mistakes and overcharge consistently. Riteaid and Walgreens are good.
5. These days we say ‘go big or go Bronze’ when it comes to choosing an insurance plan. Silver plans are generally an unhappy middle ground for individual insurance. A Gold or Platinum plan will deliver excellent benefits and cost only slightly more. If you can’t afford Gold, go Bronze and use it as catastrophic coverage.
6. Learn to love HSAs. An HSA-compatible plan has a high deductible (usually Bronze level) and specifically allows one to benefit from up to a $6650/year Health Savings Account contribution that is both tax-free going in, and tax-free coming out. The HSA funds can be used on any medical out-of-pocket expenses. HSA funds are NOT ‘use it or lose it’, as is the case with FSAs (Flexible Spending Accounts). HSA funds roll over each year, and when a person turns 65, HSA funds can even be used towards non-medical expenses. For some clients, these plans make great tax sense.
7. Know that one can only obtain individual insurance during Open Enrollment, which is now in the winter each year, unless one has a Qualifying Event by losing group insurance or moving to a new state, and signing up within 60 days of that event.
8. Know your local Urgent Care facility and avoid the ER unless absolutely necessary.