Have you ever wondered what you're actually paying for with your health insurance? Deductibles, copays, coinsurance, max out of pocket, prescription tiers, pre-authorizations...it's enough to make your head spin! And it seems like every time you look, less is covered but the prices keep going up! Whether you have employer-sponsored insurance or an individual plan, it's all just a big confusing mess that only benefits the insurance companies. Even the doctors can't stand it!
Texans face a strange world of health insurance and employer plans. The belief that good health insurance only comes from employers is widespread. But when policies sound like jumbled fortune cookies in a foreign language, people start questioning their options. So, what do you do if your work health insurance sucks?
My Health Insurance At Works SUCKS!
During the fourth quarter of every year it seems like almost every company goes through their open enrollment for benefits. And with that process comes the news about what is being done to the health insurance plan to "keep costs down". At that point, the documents stating premiums, deductibles, copays, coinsurance, and maximum out of pocket come rolling through and you feel confused about your coverage options. We have good news. There is a path to comparing health insurance coverage beyond just the health insurance premiums which everyone seems to focus on. Let's look at a plan to see how your level of coverage might stack up against your other options for health care coverage.
What are your guaranteed medical expenses for the year with each plan?
- Monthly Premiums
- Prescription Costs
- Copays for things you know you will use
- Visit Costs If Not Covered
What could be you out in Medical Costs if you had a major health event?
- Deductible Amount
- Coinsurance Amount
- Copays for things like ER visits that don't count towards your deductible
- Deductible + Coinsurance = Maximum Out Of Pocket Costs
After you have determined your guaranteed costs and what you could be out of pocket, add them up. Take that total for each plan and see what your range of commitment is for each plan that you are evaluating. This will allow you to see not only the recurring, regular costs. But you will also see the downside potential if a major event were to happen on that health insurance coverage. Knowing both the guaranteed costs to expect and the potential that you can be out of pocket will quickly expose if your employer-sponsored health insurance plan actually sucks because you can compare it to other plans available to all Texans. This kind of comparison is more important than just comparing monthly premiums. It will also allow you to do a level comparison against health care coverage that is in the individual marketplace.
So My Work Plan Isn't Great. What Can I Do Now?
f you compare your current work plan to even the policies on the Affordable Care Act Exchange and determine that you can do better, what do you do now? The great news for you is that there are options in Texas that allow you to take control of your health care and the insurance that most feel is necessary to be protected from bankruptcy. When people call our office, they always want to know what their options are beyond the exchange and work plans. So let's take a look at what those are for Texans.
- Go Uninsured - We put this simply to say it is an option. Just a dumb one. There are many options to choose from. Do not take this route.
- Health Share Plans - These plans became very popular when the tax mandate was put in place as the Affordable Care Act rolled out to require people to buy health insurance that included essential minimum benefits. Though these plans are not actual health insurance, these were considered compliant for the purposes of the ACA mandate. These health plans allow people with common interests to share health care costs and pay for routine care out of their own pocket. The downside is that it is not actual health insurance and is not regulated by the state department of insurance. If there is a problem with them reimbursing you, you are on your own.
- Affordable Care Act - These individual health plans are also known as Obamacare. They are guaranteed issue no matter your pre-existing conditions as long as you are inside an enrollment period. Typical open enrollment period is November to January for the upcoming calendar year, but there are also special enrollment periods during the year if you qualify with life events. The premium tax credits can make these plans very affordable if your household income and other provisions allow you to qualify. The number of health insurance companies offering these plans to Texans will vary depending upon where you live as the options available will vary by county.
- Private Individual Health Insurance - These plans are making a comeback now that the tax mandate has been removed. We are seeing the big health insurance companies bring these plans back to market. It potentially may be a bit more expensive than your work plan, but can provide you exactly the benefits you want to receive without being locked into a health maintenance organization if you qualify through the underwriting process. The health coverage that is offered in these individual health plans can range from high-deductible health plans to maximum health benefits, so make sure that your financial goals and cash flows match your choices made!
- Short Term Medical Insurance - These typically are fully underwritten health insurance plans that were created to provide health coverage outside of Open Enrollment for the ACA Healthcare Exchange. They offer a variety of options for true health insurance coverage, though many of the plans exclude some key coverage that many feel important like mental health or maternity benefits. These plans are also not required to cover the essential health benefits laid out in the Affordable Care Act, so some people can be caught off guard at times. The health insurance benefits that they provide can work great, but can only be used for a period of time up to three years currently. Since Short-Term Plans are not dependent upon income levels and are not job-based insurance, they are easily available to all Texans. But the reality is that they are not a long term solution unless you are an early retiree that is in the 63 to 65 age range.
- Catastrophic Health Insurance - There are many myths about Catastrophic Health Insurance floating about the internet. The way that the ACA Exchange Marketplace Plans describe it along with their age and income requirements is not the only way to obtain it. Catastrophic health care coverage does exist and it does protect you from those big events which can derail your life. It doesn't get involved in your routine care at your Primary Care Physician or typically does not require a specific provider network. But you do need to be prepared to pay for routine care visits out of pocket, which is a foreign concept to many people after all of these years of copays and "free" wellness checks. While it is not comprehensive coverage as you may think of it, the average cost for these plans is typically lower and this can be a long term solution for you until you hit Medicare.
That's Great! So Which One Should I Choose?
Which alternative path to affordable coverage you should take is a very subjective discussion. If you have a dreaded pre-existing condition it will reduce what type of health insurance options are available to you. But keep in mind that not all conditions are knock outs from coverage, so speak with an independent insurance agent who actually can sell you those kinds of policies.
The reason that we believe that better health insurance is a subjective decision is that not all out of pocket health insurance costs are the same. We have seen local Texans utilize Direct Primary Care Doctors to manage all of their routine medical services in a very cost effective fashion. That concept pairs extremely well with a Catastrophic Health Insurance plan for a very cost effective solution when compared to marketplace coverage, traditional health insurance or even employer-sponsored plans. On the converse of that, Short Term Plans have enough flexibility today to provide you a more traditional copay type situation. And there is always that Traditional Individual Health Insurance plan as well. The important thing to keep in mind are coverage gaps may be more important than just lowering your monthly costs.
So What Do I Do?
We recommend working with a health insurance agent who can present multiple options to you. Having options allows for the agent to work as a fiduciary on your behalf. They can present both the positives and negatives without an agenda to make sure that you can make the best decision for you and your family. As independent insurance agents, Insurance For Texans functions in this kind of role. If you would like to explore your options, just click the button below to see what is available to you.