Five Questions To Ask When Choosing Health Coverage

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by Sandy Dimick

Are you or is someone you know not enrolled in a health plan yet?

We’re midway through the Open Enrollment period for 2015 health coverage. Two Open Enrollment deadlines have already passed, but as we prepare to bring in a New Year, don’t forget to mark your calendar for the two remaining 2015 deadlines, Jan. 15 and Feb. 15.

Numerous available free resources and educational websites, such as www.getcoveredtenn.org and www.accessbettercoverage.org, can help provide you with the answers you need to ensure that you are choosing the right health coverage for yourself and your loved ones.

After reviewing the Access Better Coverage website, below are the five key takeaways and questions I believe you should know before you decide on a health plan.

1. Do the health care providers, hospitals and pharmacies I prefer fall within the plan’s network?

Before you decide on a plan, check with your preferred primary care provider or specialist and the pharmacy closest to you to make sure they are included in your plan’s network. In-network services and medicines are covered under the plan, while out-of-network services and medicines require additional out-of-pocket costs or may not be covered at all.

2. How much will I pay per month for coverage?

Premiums, which are usually paid monthly, are the amount you pay an insurance company for coverage, whether or not you use medical and pharmacy services. Keep in mind that these are not the only costs associated with coverage.

3. What is the amount I must pay out of pocket before my coverage kicks in?

Knowing beforehand if your plan has either a single combined deductible for medical and pharmacy services or a separate deductible for prescriptions can help ease your worries about unexpected out-of-pocket costs. Keep in mind that insurers increasingly require a deductible to be met before covering medical or pharmacy services. For example, if your deductible is $1,000, your health plan may not pay most expenses until you’ve reached $1,000 in expenses out of pocket.

4. What other costs may be required to pay for access to care?

Even after you reach your deductible, you may still be responsible for additional out-of-pocket expenses, such as coinsurance (a percentage of costs you must pay for a medicine or service) or copays (flat fees you are required to pay for prescriptions or covered services). These costs are often listed on the back of your insurance card.

5. Are my regular prescriptions covered by my insurance plan?

Each insurance provider has a tiered formulary or list of medicines covered by the plan, which determines what copay or coinsurance you will have to pay. If your medicine is not listed, it may not be covered. Make a list of your current medicines and compare it to the plan’s formulary or list to make sure your medicines are covered and you understand the out-of-pocket costs that may be associated with them.

Lastly, don’t forget that Navigators are also available to help you as you shop for health coverage. Navigators are not paid by any insurance company, but are funded through the federal government to give out free, accurate and unbiased information regarding plans and what someone is eligible for. To reach a Navigator in the Middle Tennessee area, anyone can call the Get Covered Nashville line at (615) 724-1339 or visit www.getcoveredtenn.org and check out the event calendar to see a list of upcoming events where you can receive assistance with Open Enrollment.

Sandy Dimick serves as the coordinator for Get Covered Nashville, through Family and Children’s Service, a collaboration of agencies working together to make the Affordable Care Act successful. Sandy has worked as an Advocacy Counselor with Health Assist TN since 2002, helping the uninsured across the state receive medical care and medications. Health Assist TN was adopted by Family and Children’s Service in June 2012. Before moving to Nashville, Sandy was the administrator of a physical rehabilitation agency in Florida. She is often called on by members of legislative staff, hospitals and other agencies to assist with their constituents or clients’ health care needs.