Choosing a Healthcare Plan: Experts Share Their Top 10 Tips

With all of the debate and chaos surrounding health insurance, it’s no surprise that there’s so much confusion now that open enrollment periods are finally here. Knowing a few key pieces of information before you start looking into your options can make a big difference.

So how do you pick the best plan — at the best price — for you and your family? We turned to the experts to find out. Below, Elena Prager, PhD, an assistant professor at Northwestern University’s Kellogg School of Management, and Alaina Kennedy, manager of health equity at the AIDS Foundation of Chicago, share their tips for choosing your perfect healthcare plan.

1. Don’t procrastinate.

Doing healthcare research is never fun, but resist the urge to put it off. “This is the shortest open enrollment period in the history of the marketplace,” Kennedy says. “So the sooner you begin looking, the better.” Open enrollment for the healthcare exchange under the Affordable Care Act started Nov. 1 and ends on Dec. 15. If you miss this period, your options for health insurance will become extremely limited.

2. Go in prepared.

Don’t set aside time for browsing insurance plans on the exchange marketplace only to waste it trying to figure out your username and password. Know your login information before you go in, and if you can’t remember it, visit the “get login help” page on HealthCare.gov and go through the necessary steps to access your existing account instead of creating a second one, Kennedy says. Also, make sure you have all necessary documents with you, she adds, including income information, tax information, current health plan information and a list of your prescriptions and medical providers.

3. Pay off any remaining balances on your current health insurance.

“If you owe a back-payment or have a balance, you may not be able to enroll in a marketplace plan for 2018,” Kennedy warns. Cover your bases by calling your current insurance provider and checking to see if you owe anything.

4. Don’t let your current health insurer automatically renew your healthcare plan.

While it may seem easier to just stick with what you’ve got, a new year means new, possibly better plans, as well as changes to existing plans. “It pays to shop around,” Kennedy says, “and if you don’t, you may end up getting a worse deal or finding that your doctor is no longer accepting that insurance plan.” Whichever plan you end up with is yours for a year, so don’t take the risk of failing to fully research your options.

5. Make sure your physicians and prescription drugs are covered by the plan you choose.

You don’t want your new insurance plan to disrupt your current health routine, especially if you’re on prescribed medications. And don’t be put off by a narrow-network plan if it includes what you need. “If they’ll cover your current doctors and drugs, this can be a good deal even though you lose some flexibility to see other new doctors in the future,” Prager says.

6. Getting insurance through your employer? Don’t dismiss high-deductible plans, especially when they’re paired with an HSA.

“A high-deductible plan may seem scary,” Prager says, “but employers often match your contributions to an HSA if you enroll in a high-deductible plan.” So while the deductible itself won’t necessarily be helpful in the case of expensive care, she adds, “many employers will cover as much as 50 percent through HSA contributions that are essentially free to you, which effectively lowers the deductible.”

7. Sometimes it’s cheaper to go with a higher premium plan.

A higher premium can actually save you money in the long run. “If you’re planning on having some higher-than-usual medical costs in the upcoming year, such as due to a pregnancy or planned surgery, it may be cheaper overall to pay a higher premium for a plan that will cover those costs more generously,” Prager says.

8. Understand the metal tiers.

You’ve probably noticed that, at least in the exchange, all plans are associated with some type of metal — bronze, silver, gold or platinum. “All exchange plans within a metal tier are required to give you roughly the same financial benefits relative to the premium,” Prager says. When comparing plans within the same metal tier, she says, pay attention to how each plan accomplishes this. “If you typically consume little healthcare but want risk protection in case of a serious illness, consider plans with higher copays but low out-of-pocket maximums,” she adds.

9. Be patient with the HealthCare.gov website.

The website is working better than ever, Kennedy says, but a 33 percent increase in traffic compared to 2016 means that delays are to be expected. And be aware of the scheduled maintenance on the site, which will be taking place every Sunday during the enrollment period, except Dec. 10, from midnight to noon EST.

10. Frustrated? Ask for help.

“You don’t have to do it alone,” Kennedy says. Enrolling in healthcare can get complicated, but assistance is available. The marketplace call center can be reached at 1-800-318-2596 and is accessible 24 hours a day, seven days a week. If you’re enrolling in Illinois, you can visit getcoveredillinois.gov and make an appointment to discuss your options, or visit ilcha.org/help.