- Posted by Canopy
- On December 18, 2014
- 0 Comments
- avoid costly health insurance, canopy
Buying health insurance has become a big deal these days. With the implementation of Obamacare, the single largest healthcare reform legislation ever passed, the game has changed….dramatically. There are more rules in regulations in place relating to health insurance than there ever has been and unfortunately, people are largely uninformed which leads to many health insurance mistakes in Kansas City. The danger in this is the number of consumers who buy plans without assistance. They simply go online and buy. They don’t seek help from any number of different health insurance agents in Kansas City, who can advise them appropriately on plan options, and instead try to figure it out on their own and buy what they think looks good. Over the past year, I’ve seen this scenario play out too many times and still cringe each time I talk to someone who bought a plan they didn’t understand with network restrictions or benefit nuances they weren’t aware of. They’re usually calling us for help because the plan they bought isn’t a fit. Sometimes we can help but sometimes it’s too late. I still maintain the worst thing someone can do is try to buy health insurance on their own, without counsel or advisement from a licensed agent. However, many people think “I got this” and buy a plan on their own not fully realizing what they’re purchasing. Bottom line, you need health insurance help in Kansas City.
Avoid Costly Health Insurance
Here’s a couple reasons why:
Know your Network: Last spring, I read a story about a man in California that had an Obamacare plan couldn’t get his medical needs taken care of because his providers didn’t accept ACA plans (read about it here). The problem isn’t that his doctor doesn’t accept ACA plans. I’m positive they do. The problem is the man unknowingly purchased a limited network plan and HIS plan with the limited network is just that – limited. His providers aren’t included in the plan he purchased and this is a scenario that plays out every day with people buying health insurance, especially when they’re buying without the help of an agent. Usually the scenario plays out like this:
- Individual looks at quotes online
- Plans are arranged by price – lowest to highest
- The limited network plans that look identical to the larger network plans are priced 15-20% lower
- Individual purchases the limited network plan with the lower premium
- Individual doesn’t realize they have a limited network until they go to use the plan
Furthermore, these limited network plans often have significant out of network claims exposure; one plan I’m familiar with in our area has a $25,000 out of pocket maximum for out of network claims! So if you have one of these limited network plans and have to seek treatment out of network, get ready for a huge financial hit. Unfortunately the plans don’t have a big red sign on them when people go to buy them. They look innocent enough next to the others and have a lower premium so people are naturally drawn to them and buy them without knowing the restrictions. We reviewed some important items to note about healthcare.gov right here
Out of Pocket Maximums are key I can’t count how many times I’ve spoke to a consumer that almost exclusively focuses on the deductible amount of a plan. While the deductible definitely matters, it’s not the end all be all. Most of the time people don’t understand that health insurance plans carries additional exposure beyond the deductible in the way of coinsurance, until the out of pocket maximum is reached. When the out of pocket maximum is reached, the health insurance covers 100% of the claims for the remainder of the year. Out of pocket maximum is your worst-case scenario so it’s important to know that figure. If you have a major health event, the out of pocket maximum will be your cap. If your family has multiple events in one year, the family out of pocket max is your cap. Given the cost of health care in our country, out of pocket maximums are easier to hit making it all the more important you know the worst case scenario of the plan you buy. The worst-case scenario is your out of pocket maximum – know that number and pay close attention to it when you’re comparing plans. Not knowing your out of pocket maximum can lead to financial surprises (not good surprises) down the road.
Let Canopy Help
To get additional tips on what you need to know when shopping for health insurance, be sure to download your free copy of our Health Insurance Buyers Checklist right here!