Family
November 5, 2015

How to pick a plan on Health Insurance Exchange

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Aren’t sure where to start? We have tips for you.

 

If you are shopping for a health plan on the Health Insurance Exchange, it’s time to enroll for 2016 coverage.

Even if you’ve used the Healthcare.gov site to enroll before, it is a new concept for many people. You aren’t alone if you’re aren’t sure where to begin.

The first thing to know is that the open enrollment period in what is also known as the Health Insurance Marketplace began Nov. 1. There are several deadlines you should know:

  • The last day to enroll is Dec. 15 for coverage starting Jan. 1, 2016.
  • The last day to enroll is Jan. 15 for coverage starting Feb. 1, 2016.
  • The last day of open enrollment is Jan. 31 for coverage starting March. 1. If you don’t enroll by that date, you won’t be able to enroll in a plan for 2016 unless you qualify for a special enrollment period.

 

What is the Health Insurance Exchange?

The Exchange is a “virtual marketplace” through Healthcare.gov for people seeking health insurance who do not receive health insurance from an employer, Medicaid, Medicare or the Children’s Health Insurance Program (CHIP). What you pay for a plan depends on your predicted income for the upcoming year. The lower your income, the lower your costs. Once you’ve found the plan that’s right for you, you can apply directly through Healthcare.gov, or by phone, mail or with in-person help.

 

Here are some tips for choosing a health plan:

  • Think about what you need in a plan. Each health plan offers different benefits and coverage to meet different needs. Do you only visit the doctor when you’re sick? Are regular check-ups important to you? What about eye exams? Don’t settle for the first plan you see. Plans change every year, including what they offer — so even if you’ve had coverage previously, make sure that plan still meets your needs. On Healthcare.gov, you can compare plans side by side.
  • Understand the “metal levels” of coverage. Plans on the Exchange have ratings that show you how you and your plan would share costs. Keep in mind that these ratings, or levels, have nothing to do with the quality or amount of care you receive.
  • Know the differences between HMO and PPO plans. In an HMO (health maintenance organization) plan, you typically have to visit a hospital or physician on the plan’s approved list of providers, except in emergencies. With a PPO (preferred provider organization) plan, you can choose your hospital or physician. A PPO still has a preferred network of hospitals and physicians, and you’ll pay less for a visit to a preferred provider. However, if you would like to visit a non-preferred provider, you can but may have to pay more to do so.
  • Check the plan’s provider network. Do you have a particular physician or hospital of choice? If so, double check that your provider preferences are included in the plan’s network. If they’re not included, you may have to pay more out of pocket.
  • Look at quality ratings for each plan. Consumer Reports and NCQA are excellent sources for quality ratings based on 5-star ranking systems. At these sites, you can compare hospitals, providers and insurance plans.
  • Read the fine print. Be sure you understand the plan’s co-pays, deductibles and other important plan details. It’s essential that you know in advance how much you’ll have to pay for a doctor’s visit, procedure or hospital stay.

 

2 thoughts on “How to pick a plan on Health Insurance Exchange”

  1. sandy mcbride says:

    I called Vanderbilt today & they told me that the only MARKET PLACE insurance that Vanderbilt is taking is BCBS S. Its a HORRIBLE plan,Pricey and you have to pay 50% co pay. Why bother telling people about the Market Place when that is the ONLY insurance that you will accept through the Market Place? I feel backed into a corner here. I have one doctor there, that I have had and truly trust and like. This whole thing is NOT fair.

    1. Cynthia Manley says:

      Sandy, I am sorry to hear about this frustrating situation. Let me offer you a different number to call in case that is helpful to you. Vanderbilt is included in more one of the BCBS plans on the Exchange and, I think, at different price points. The companies that offer plans on the Exchange determine which providers are included in their networks and set the premiums. I am hopeful that you’ll find a plan that will allow you to continue to see the doctor with whom you have a relationship. Here is the phone number: (800) 365-3148.

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