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While the Affordable Care Act may have put health insurance coverage within reach for many Americans, many Americans are opting not to use it once they have it. From Gallup and Kaiser Family Foundation polls to TransUnion Healthcare and Families USA studies, the consensus seems to be that despite lower monthly premiums under Obamacare, individuals and families with private health insurance plans still struggle to pay high deductibles and out-of-pocket costs.
The solution for many? Skip care or put it off. People who had a deductible more than 5 percent of their income were consistently more likely than those with a deductible less than 5 percent of their income to skip a medical test, treatment or follow-up recommended by a doctor; to avoid going to a doctor or clinic when they experienced a medical problem; not get a preventive care test; neglect to go to specialist when they or their doctor thought they should; and have at least one cost-related problem.1
It can be a slippery slope. Visiting the doctor may cost money, but not visiting the doctor and going without diagnosis and/or treatment may cost even more—in terms of both finances and health.
If you find yourself among those who don’t seek medical care and you have not used your health insurance due to high costs, here are three actions you might consider:
1. Use no-cost preventive care benefits.
Did you know your Obamacare health insurance plan includes dozens of preventive care services for men, women and children? Certain immunizations, screenings, counseling, office visits and supplements are covered at no additional cost beyond your monthly premium.
To get more out of health insurance benefits, take advantage of the “free” preventive care covered by private, ACA-compliant, non-grandfathered health insurance plans. Visiting the doctor when you are healthy can help prevent diseases and detect them early, when they are often more treatable and less costly to treat.
Always confirm benefits and provider networks with your health insurance plan. If you have any questions, contact your health insurance plan’s member services department—it’s typically listed on your health insurance card.
2. Consider switching plans during 2016 open enrollment.
Pay attention to how you use your health insurance benefits throughout the year—and why you don’t use them. Does your health insurance plan continue to meet your financial and health care needs? Is your monthly premium affordable while care is not? It may be time to reconsider your plan options when 2016 open enrollment begins Nov. 1, 2015.
Keep in mind that a lower monthly premium typically translates into higher out-of-pocket costs and vice versa. Get to know the Obamacare metal levels and consider which might be best for your needs. If you are relatively healthy, you may find a high-deductible health insurance plan with minimal cost sharing (e.g., a gold plan) attractive, but make sure you still consider the deductible, coinsurance, copay and maximum out-of-pocket amounts. If the unexpected occurs, are you able to realistically pay for medical care?
You could be on the hook for thousands before your plan benefits kick in and even more before you reach your out-of-pocket limit.
For ACA-compliant health insurance plans in 2015, the maximum out-of-pocket cost limit is $6,600 for self-only coverage and $13,200 for family coverage—this amount does not include your premiums, out-of-network care, and non-essential health benefits.2 In 2016, the maximum annual limitation on cost sharing jumps to $6,850 for self-only coverage and $13,700 for family coverage.3
You may need a little guidance in selecting the best health insurance plan for you and your family. Consult an exchange-based helper or licensed insurance broker if you shop a state-based or federally facilitated health insurance exchange. You may also reach out to a health insurance agent or broker. Insurance brokers can help you whether you are shopping on or away from the state and federal exchanges. The IHC representatives available through healthedeals.com are also a helpful resource—get a quote at healthedeals.com/major-medical-insurance or call 888-839-7679.
3. Enroll in a supplemental health insurance plan.
Ancillary health insurance plans such as Metal Gap complement your Obamacare health insurance. This supplemental coverage fills the gap between first dollar and maximum out-of-pocket costs for those with high deductible health insurance plans. In other words, Metal Gap, which is sold through healthedeals.com, can help you pay your deductible and other accident- and illness-related costs.
Here’s how it works:
If you experience a covered accident or critical illness, you receive a lump sum payment from Metal Gap based on the benefits you selected. You may use your Metal Gap benefits to pay your deductible, coinsurance, copay and any household expenses such as car payments, groceries, child care and more.
Metal Gap is guaranteed issue, which means you cannot be denied coverage, no matter your health history. It also includes prescription and vision discounts to help reduce other medical costs.
Don’t wait for open enrollment. You can enroll in Metal Gap year-round.
If you have questions about Metal Gap or need help making a plan selection, contact an IHC representative at 888-839-7679.
1 Ungar, Laura and Jayne O’Donnell. “Dilemma over deductibles: Costs crippling middle class.” USA Today. Jan. 1, 2015.
2 HealthCare.gov. “Out-of-pocket maximum/limit.” https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
3 Centers for Medicare & Medicaid Services. “Final HHS Notice of Benefit and Payment Parameters for 2016.” Feb. 20, 2015. http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/2016-PN-Fact-Sheet-final.pdf