Open enrollment for Obamacare and Medicare happens every year, and this is the time where you get to decide which health plan you want for the coming year. Because this is an ever changing industry, there are some important things you need to watch out for. The four main things most people look out for in a health plan, are rates, benefits, network of doctors and hospitals and covered prescriptions. If you look at just the rates, you could be making a big mistake. On the surface this seems so simple, but not always, because health plans tend to change all of these things every year. That is why when you renew your health plan, whether it be your individual Obamacare plan or Medicare Advantage plan, it is important to check these items, because as you may know, once you make the choice, you're kind of stuck until next open enrollment.
Most people who renew with the same plan just look at the rates, assuming everything else will be the same as before, but there may be some subtle changes to the plan as well as the network. Here's a checklist of some of the things to look out for. First of all, make sure your doctors are still going to be in your plan for the coming year. Many times the doctors are part of a hospital network, and the hospital network may be in negotiations with an insurance company. We had this happen last year and many of our clients had to change insurance companies because their doctors were not going to be part of that company for the coming year. And for the individuals who did not know this, it became an issue.
Second, look at the changes in copays and out-of-pocket maximums. Every year, the marketplace plans tend to have a slightly higher out-of-pocket max, and in some cases changes to the copays for office visits, prescriptions, as well as several other things like urgent care and emergency rooms. It's just a good idea to be aware of some of these changes so that you're not taken by surprise.
Third is prescriptions. With new medications coming out all the time and some of them being very expensive, you want to make sure that your medications are going to be covered and what tier they will fall under. Most health plans have four tiers for prescription medications, which are generic, higher price generic, preferred brand, and higher price brand or specialty medicines. We have seen many plans make changes to prescription tiers, leaving our clients having a much higher copays and out-of-pocket cost, and if you're on a fixed income, some of these changes could be disastrous to your finances.
And finally, you have to check the rates and be careful when you do this because as I mentioned before, not all health plans are the same, and sometimes it is better to stay with the devil you know, especially if it is serving most of your needs. There are many new health insurance companies now coming into the marketplace every year, and often they're coming in with much smaller network of doctors and hospitals. This is where your insurance agent can be a great asset for you to help you make sure that you're checking the proper boxes based on your personal needs. Just make sure you're working with a qualified agent who represents many different companies and can help you make the right decisions. If you want to learn more about how to shop for health insurance and find a good agent, check out our video on dangers for shopping for health insurance.
Let us know if we can help you with your individual health insurance or Medicare plans in GA.
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