Tuesday, October 23, 2018

Insurance Inspection: It's Open Enrollment Time

Today, I share with you some wise words from a post op Cushie and patient advocate, Susan G. She moderates the Facebook group, The Many Faces of Cushing's

Spend some time learning about your health insurance coverage.
"Open Enrollment for insurance will be starting very soon. Now is the time to look over your plan very carefully and make any changes. Look at your provider directory online, and search for some of the major medical facilities (MD Anderson, John Hopkins, Cleveland Clinic, Emory, Mass General, Cedars Sinai, etc). See if LabCorp and Quest are covered medical labs. Look at your out-of-network requirements/costs.
If you are going to aggressively seek treatment (especially surgery) in 2019, find a plan that gives you a wide range of options. For instance, if you know you want Dr. Chiang to perform your bilateral adrenalectomy, move to a plan that lists him as a provider. Your monthly premiums might go up, but that will be less expensive than paying for surgery out-of-network.
Don't assume that the "standard" (more expensive) is better than "basic" (less expensive). Because I am post-surgery, and most of my medical expenses are lab tests, I switched to the Basic plan because they cover labs at 100%. Yes, if I end up having to have surgery the hospital costs will be higher, but probably not much more than I've saved on premiums throughout the year.
Don't assume that the lower deductible plan is better. Look at the various copays and premiums. A high deductible may never be met (if you are fortunate and don't have to see many doctors) but those premiums are a guaranteed expense.
Finally, remember that this is an election year probably one of the most important of our lives. Denying coverage for pre-existing conditions is still a possibility, and Medicaid is on the chopping block. Vote for your Senators and Representatives like your life depends on it -- because this year it might.

Just in case someone is not really familiar with the terminology:

Deductible is the amount that you will be required to pay out of pocket before insurance starts paying anything. 

Annual out-of-pocket is the total amount you will have to pay. In other words, it includes your original deductible and then the amounts that insurance won't cover ($50 emergency room copay, 20% of surgical procedures, etc.). Once you hit the OOP, you pay nothing the rest of the year."