How to Evaluate Your Healthcare Needs + Obtain Enough Insurance Coverage

Jenifer Dorsey
2018-09-11 November 21st, 2017 |
Read time: 7 minutes

Open enrollment seems to sneak up on us every year. You’re still working through the Halloween candy and suddenly are being asked to make an important and—for most of us—mandatory purchase that will cost potentially hundreds of dollars or more each month.

Before you let your current plan automatically renew or simply go out and buy the least expensive plan you can find, it’s a good idea evaluate your current plan and healthcare needs. Did your health insurance work for you during the past 12 months or did you experience gaps in your coverage? What changes might you want to make for the coming year?

Assessing your past health + coverage

You probably know that certain qualifying life events make you eligible for a special enrollment period for health insurance outside of annual open enrollment.

These include things like losing or changing jobs, turning 26 and losing coverage through a parent’s plan, getting married or divorced, having a child, and moving to a different ZIP code or county.

Perhaps you experienced one of these changes in the last year and didn’t update your health insurance at the time. If so, now’s the time to make sure you have adequate coverage.

Did you develop a health condition over the past year that will require ongoing management, such as the use of prescription drugs?

If so, you may need to look for a plan with a lower prescription drug co-pay, make sure that the medications you’re taking are covered, and that your preferred health care providers are in your network.

Were the in-network facilities like urgent care, hospitals, clinics, and rehabilitative centers convenient?

If you found that you had to drive out of your way to access in-network providers, you may want to make a change for next year. Similarly, if you have preferred doctors make sure they’re included in the network of any new plan you’re considering.

Are you planning to start a family in the coming year or do you have a planned surgery coming up? 

These anticipated life changes could necessitate changing over to a plan with higher monthly premiums that pay a larger portion of your medical costs.

Did you go to the dentist last year? Do you anticipate needing dental work in the coming year?  

For children, ACA (Obamacare) plans include some form of dental care as an essential health benefit. For adults, Obamacare plans generally don’t have it and it’s not a part of individual major medical policies. If you anticipate needing dental work next year, consider rounding out your benefits package with additional dental coverage.

Did you get stuck with a huge deductible payment when you went to use your plan last year?  

For some of us, the only plan that’s affordable month-to-month may be devastating to our finances should we actually need to use it because of the higher deductible. If you experienced that last year, you’re understandably worried about enrolling in a lower premium/high-deductible plan again next year. Don’t worry – there is an affordable alternative in the form of supplemental health insurance (more on that below).

Changes to make for the coming year

If you find that you’re stuck with a high deductible health plan—often the case for younger, healthy adults—supplemental health insurance (aka “medical gap” coverage) may be the answer. This is a guaranteed issue ancillary plan to help fill the gap between the first dollar and the maximum out-of-pocket costs in the event you experience a covered critical illness or injury.

The lump-sum benefit is sent directly to you. The payment does not need to cover medical-related expenses; you can use it to pay for anything, from your deductible to the mortgage to groceries.

Be prepared for next year’s open enrollment

Health insurance markets and the ACA will continue to change from year to year. How can you help set yourself up for success when open enrollment comes around again next year?

  • Track your claims for next year’s open enrollment. What did you pay for and what did your insurance cover? For any ongoing medications or treatments you’ll want to be able to make an apples-to-apples comparison to find the best coverage and value.
  • Complete your preventive care early in the year. This helps ensure that you have the full scope of your healthcare needs, including any new medications or treatments, so that you can factor them in to your decision for next year’s open enrollment.

A licensed health insurance producer can assist you in making decisions about ACA-qualified major medical plans as well as additional coverage to help pay for out-of-pocket healthcare expenses. Use Agent Finder to search for local assistance.

 

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Originally Published On March 23rd, 2015