David Sayen
Courtesy: Medicare
When you shop for health insurance at HealthCare.gov, you will have a variety of plans from which to choose. Look for a plan that meets your health needs and fits your budget.
You should consider factors such as the monthly premium costs, the yearly deductible, what services are covered before you meet the deductible, whether your doctors are in the plan’s network, whether prescription drugs you need are covered and whether you qualify for cost-sharing reductions that limit your out-of-pocket costs.
Keep in mind that the final enrollment deadline for 2016 coverage is Jan. 31, 2016.
While premiums are often a deciding factor, other out-of-pocket costs could be just as important.
Factoring in such costs has always been part of buying health insurance, but HealthCare.gov now offers resources to help you better understand your choices.
These new features allow you to see your total estimated out-of-pocket costs, search health plans by your preferred provider and see whether your prescription drugs are covered.
One key out-of-pocket cost is a plan’s deductible.
A deductible is the amount you owe for the health care services your plan covers before your insurance begins to pay. Preventive services like cancer screenings, immunizations and well-child visits are always covered without any additional cost to you.
But keep in mind that many plans cover the costs for other key services before you meet your deductible. So, even though your plan has a deductible, it might not matter for the services you use most frequently, like primary care visits or generic prescription drugs.
In 2015, more than eight in 10 consumers selected a plan that covered some popular health services (beyond preventive care) before the deductible was met.
Here are five things to know about deductibles in Marketplace (HealthCare.gov) plans:
• All Marketplace plans cover recommended preventive services without a deductible. Services like cancer screening, immunizations and well-child visits are covered without a deductible, co-pay or other costs to you.
• Many other health services are often covered without a deductible. Many plans provide some benefits before you meet the deductible. Thus, you may be able to visit your primary care doctor or fill a prescription for a generic drug and pay only a co-pay — a small, fixed amount you pay at the time of service. Even specialist visits, mental health outpatient services and brand-name drugs are often covered with no deductible, although you will still be responsible for the co-payment or co-insurance.
• Check what your plan covers without a deductible. Plan benefits differ, so when you find a plan that you’re interested in, click on it on HealthCare.gov and look at the “costs for medical care.” It will tell you which services have a deductible and which ones do not. For a more detailed view, click on a plan’s “Summary of Benefits and Coverage.” You will see how the plan’s deductible applies to different services.
• Consider services covered without a deductible along with your monthly premiums, deductible and other out-of-pocket costs when choosing a plan. It’s important to understand what your insurance covers without requiring you to pay your deductible. Then you can decide how to trade off monthly premiums; out-of-pocket costs, including the deductible; and the services covered without a deductible. For instance, do you want a plan with lower monthly premiums and a higher deductible, or one with a higher monthly premium and a lower deductible? In order to better understand your total out-of-pocket costs, you can use the Out of Pocket Cost feature on HealthCare.gov to estimate your premiums, deductibles and co-pays for the year, based on the number of times you go to the doctor or get prescription drugs.
• Silver plans can save you more. If you qualify for cost-sharing reductions — as most Marketplace customers do — you can save more. A family of four whose income is below $60,625 can qualify for additional savings with lower co-pays, a lower deductible and more services covered with no deductible. This financial assistance is only available if you purchase a Silver plan. Although a Silver plan may have monthly premium that is higher than a Bronze plan, be sure to consider your total costs. If you qualify, your maximum annual out-of-pocket costs could be lowered by thousands of dollars. Your deductible could be lowered as well.
You should feel confident that you’ve picked the right plan. If you have questions, there are a number of ways to get free, personal help.
Representatives at the Marketplace Call Center are available 24 hours a day, every day (except for Thanksgiving and Christmas Day) at 1-800-318-2596. They can answer questions and help you enroll in coverage over the phone. Free help is also available in communities across the nation. Visit HealthCare.gov to find help in your neighborhood.
David Sayen is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
