November 1, 2015 marks the beginning of open enrollment for the U.S. Health Insurance Marketplace (Affordable Care Act). For those of you who are self-employed, or work for an employer who does not provide insurance, now is the time for you to start reviewing your health care needs over the past year, and what you might need in the upcoming year.
In this article, I provide a few tips to get you started. If you are looking for health insurance coverage for your family, include all dependents in your estimate.
1. Write down your health history for 2015
Take out a blank sheet of paper, and estimate the following (it is okay if it isn’t precise). How often did you visit a primary care physician and/or specialist? If you had prescription medications, how many did you have per month (on average), and were they generic, brand, or specialty? Did you visit urgent care or the emergency room in the past year? Did you have any procedures or surgeries?
How much did you pay for your premiums in 2015? How much did you come out of pocket for services, and did you reach your out-of-pocket maximum? The delicate balance of selecting a health plan is trying to find an affordable premium that will cover the majority of your expected costs, with minimal out of pocket expenses. Reviewing this information will help you decide if you want to make changes in the upcoming year.
2. Estimate your need for 2016
Of course, none of us can fully predict when we will need medical services. If you only visit the doctor once or twice a year, have only a few (or no) prescription medications, and don’t expect any changes in the upcoming year, record that. However, consider your financial appetite for risk. Are you willing to pay a deductible if you do end up visiting urgent care or the emergency room? Now is the time to reflect on that.
On the other hand, if you have been thinking about having a specific surgery in the next year, know that you are managing a chronic condition, or are trying to conceive, think about what services you would like to have covered under your plan, and how much you are willing to pay upfront (in your premium) versus at the time of service.
3. Consider the plans available in your state
Identify the plans available to you by visiting the U.S. Health Insurance Marketplace and selecting your state of residence. Currently, 2015 plans are available for those who have a special enrollment period (qualifying move, change in employment, loss of coverage, or marriage). By selecting your state in the drop-down menu, you can get an idea of plan options and costs for 2015. When open enrollment begins on November 1, you can use this site to select plans for 2016 (with coverage beginning as early as January 1, 2016).
Depending on whether your state runs its own exchange, you may be directed to a different site to help you select options for 2015 (and in some cases, information is already available for 2016). For example, Covered California will ask you information about your household income, zip code, and age of dependents (this information is used to help determine eligibility for premium assistance or tax credit).
The screenshot below shows 2016 cost estimates for a specific metal tier (gold, in this case) for an individual who may be eligible for a tax credit. Final costs are calculated once all of the applicant’s information is reviewed.
Using this information will help you better compare different types of plans and narrow down your options.
4. Select the plan that is right for you
In my ebook, The Empowered Consumer’s Guide to Choosing a Health Plan, I introduce you to the U.S. Health Insurance Marketplace and guide you through the health plan selection process using customized worksheets. The topics discussed help to demystify the Affordable Care Act, including information on metal tiers (by which plans are identified), penalties, tax credits, how to ensure your doctors are covered by a particular plan, and tools to help you compare actual costs for plans (hint: looking at the premium isn’t enough!). I also point out information of interest to the self-employed, such as deducting your health care expenses.
This book has been useful to people in a wide range of situations, including those who have not traditionally used the U.S. Health Insurance Marketplace but are looking for lower cost alternatives to their private insurance, and those who have health coverage through their employers but need options for less expensive coverage for their dependents. One reader commented,
After reading the book I was able to shop for new health plan. I realized that my employer based coverage for my child cost nearly $200/month more than a platinum plan I could buy on my own. I’m counting down the days until open enrollment
This guide is available on Amazon.com for $2.99, and is free to subscribers of Kindle Unlimited. If you found this post useful, please comment below and share with a friend!