What Does Price Transparency Mean For Healthcare?

When it comes time to shop for a new health insurance plan, or evaluate your current one, asking the following questions gives you the confidence you need to make a decision that ultimately serves you best. Pro-actively asking these questions will increase your chance of happiness in living with the policy you ultimately choose. The following questions are guidelines that help measure the elements of a policy and can reveal the things that are most important to you when it comes decision time! Waiting until the last minute to make a choice can cause un-do stress, so let's dive right in! ► 1) Is it easy to see the healthcare provider of my choice? When the Affordable Care Act was rolled out in 2010, it created uniformity among health insurers and eliminated some of the creativity within their product offerings. What came to the forefront, was the insurance company's ability to be distinctive, and in some cases, exclusive with the provider network's they offer. If a provider or a specific health care delivery system is important to you, you can narrow down your choice of plans by first checking to see if your doctor and/or hospital is on their in-network list. Insurance carriers always provide a search function on their website with their most recent list of providers. Also, placing a phone call your doctor's billing office directly is the absolute best way to find out if they're actively a part of the network you're considering, and plan to be in the near future. ► 2) Am I willing to enroll in a plan that covers services performed by in-network providers only? Some plans are offered at lower premiums because they contract with a specific group of providers. These are typically called HMO (Health Maintenance Organizations) or EPO (Exclusive Provider Organizations) plans. These providers agree to contract with the insurance company by limiting what they can charge for services. This allows the insurance company to lower premiums because they are controlling the cost of services, and therefore, their risk of lost. ► 2) Do I thoroughly understand how a claim is handled if I visit a provider that is out-of-network? There is no surprise worse than finding out that you've incurred a claim with services performed by an out-of-network provider! When choosing a plan, it's important to understand that you will be responsible for cost of services when stepping outside of the contract guidelines of your policy. If you knowingly or un-knowingly use the services of an out of network provider, learning how your carrier handles out of network claims - in advance - could save you thousands of dollars. ► 4) To enroll in a plan with a lower premium, am I willing to change to a new doctor? It's never easy having to consider changing your healthcare provider, especially when the relationship has a history spanning many years. At the same time, financial concerns such as budgeting for your monthly premium, may need to take priority if it's the only policy you can reasonable afford. Working with a professional agent may help take the sting out of this decision, especially if they offer solutions you may not be able to find on your own. ► 5) Can I afford the policy I have? Bottom line to any choice you make in life is, can I afford it? If you are in the individual market (vs. employer group market), it's important to understand that you only have the ability to access a new insurance plan one time each year at the annual open enrollment period. Of course there are exceptions to this rule as you may have a special qualifying event. But, for the purpose of this writing, you'll want to make sure you're comfortable with the premium so you'll keep it active for a specified amount of time. ► 6) Am I eligible to receive a subsidy through Healthcare.gov? Financially, there are three ways to access your individual health insurance policy: A) You may go directly to an insurance company and enroll. B) You may go to Healthcare.gov to apply and see if you qualify for a premium subsidy. If so, you may shop for specific plans offered to those who access it through the marketplace, aka SHOP. C) After applying through Healthcare.gov, you may find that you qualify for your state's Medicaid health plan, in which case you would not have to pay a premium for your coverage. ► 7) Am I comfortable with the cost sharing portion of my policy, which includes deductibles, co-pays, co-insurance, and the annual out-of-pocket maximum? Plans offer various combinations of the following four basic components. Knowing the amount for each one, plus understanding its function goes a long way toward being comfortable with your choice of plans. A) Your annual deductible amount B) Specific co-pays for specific services C) Your co-insurance percentage D) The maximum out-of-pocket amount you will pay for covered services each year. ► 7) Am I willing to lower my benefits so that I can more easily afford the policy and keep it active? Compromise is never easy when it comes to the important decisions in our everyday lives. It's no secret that health insurance premiums are higher than ever, so it's important to position your thinking around flexibility when assessing your true needs and wants. Deciding what's most important first (need), then building your list of wants helps zero in on the best plan to pursue. ► 9) Do each of my family member have different needs? Not all family members have the same healthcare needs. You might wish to consider enrolling in different policies if it makes sense to do so. Of course, there's criteria to consider if you've qualified for a subsidy, are enrolling in a health savings account, or you have a large family and want to keep the out of pocket maximums limited under one policy. ► 10) Is my health insurance company responsive to me? Is my insurance carrier easy to communicate with? In the past, have they handled my issues or complaints in a timely manner? Asking these questions determine your level of trust in your current carrier. As with any other business, a company earns the right to be trusted, and when the rubber meets the road, customer service may make the difference in how you value of your insurance policy. ► 11) Does my health insurance company provide value-added benefits that are beneficial to me? Does your insurance company offer extra perks such as discount memberships for vision services, fitness programs, smoking cessation, and a 24 hours nursing line? These are some of the value added benefits offered by carriers. Do they offer free video doctor visits? Do they offer you a mobile app to set appointments and access replacement copies of your ID cards? Look for these and other programs they offer to make your busy life easier. ► 12) How important are alternative care providers and benefits to me? If natural medicine is important to you, seek a health plan that builds in alternative care visits such as chiropractic, acupuncture, and massage services. When it comes time to review your current plan, or you're newly entering the world of health insurance, consider keeping this list handy! Please let me know if this has helped you by leaving a comment below. Feel free to share it with your friends on social media.