Buying medical coverage is not easy or fun, and can take up a lot of your time. And of course, without the best available information and guidance, you may end up purchasing the wrong policy and pay thousands of dollars more than you should. The process can be very confusing. Which plan is the cheapest and best? How do you calculate your subsidy? What’s the difference between a Silver plan and a Bronze plan? If I miss the Open Enrollment deadline, can I still purchase quality coverage?
We have created a “Top-Ten” list to help guide consumers as they get ready to buy healthcare insurance. We’re confident this list of recommendations will save you time, money and frustration! Choosing the right medical plan just got easier.
- 1. Carefully choose the websites you visit. If you see numerous advertisements mixed in with the content, you may want to find another website. The articles you see should be relevant and constantly updated. There should be a significant amount of recent content devoted towards the State Exchanges and Open Enrollment. If you are reading an article that appears to have been recently written, and it is actually a few years old, this website probably won’t help you.
- And you may possibly receive outdated and inaccurate information. Rates change each year, and carriers typically change deductibles, copays, or the maximum out-of-pocket expenses ($9,100 for 2023). Occasionally, a carrier will no longer offer plans in specified counties, or may entirely exit a state. For example, recently, UnitedHealthcare and Cigna have re-entered several Marketplaces.
2. State-specific websites are typically trustworthy. Thus, if you live in Virginia, some of the content on the site should revolve around Virginia medical issues, not other states. If a website specializes in travel abroad and you’re interested in an HSA, you’re on the wrong website! However, we did write a nice article if you plan on traveling abroad. Also, national websites that devote entire pages to a specific state (like ours) can be very helpful. Typically, content is regularly updated.
3. Never pay an agent or broker a fee. You don’t have to. Agents and brokers are compensated by the carriers, and there is never a reason for you to pay them any additional amount. Also, rarely are there ever any fees when you apply for coverage, although short-term plans may impose a small administrative charge. But they are usually only $10-$20. Some of the questionable policy options online charge a $100 application fee. Stay away from those types of offers. Also, there is never a reason to disclose private financial information before you actually apply for coverage. You should never divulge your social security number or credit card information.
4. If you are replacing an existing policy, request an effective date far enough in advance so that you have time to review the new plan. For example, by asking for an effective date 45-60 days from the application date, you’ll be able to closely examine policy differences with your broker. Of course, if you need coverage immediately, this may not be possible. If you have no medical issues, and you missed Open Enrollment, the underwriting process for short-term coverage may only take a few days. But, secure catastrophic benefits as a wise alternative to having no coverage.
5. Be aware of “pre-existing condition” clauses on grandfathered plans and how it affects you. If you are being treated for a condition, it’s important to understand if the new policy will cover your medical costs and if there will be a waiting period. If you take a non-generic prescription, the policy should not just cover generic prescriptions. And mail order should be an option. During the OE period, pre-existing conditions are not a factor. However, you need an “SEP” exception if you wait too long to apply, or are without coverage.
6. Don’t invite strangers to your home so you can view a proposal. If a broker or company can not email, fax or send (through the mail) a specific proposal and explanation of coverage, then find someone new to work with. Most (perhaps all) reputable healthcare professionals can easily provide the information you need within an hour…and often within a few minutes. There is never a reason someone would have to make a home visit. If you receive an unsolicited personal visit, be very wary, and avoid contact.
7. Only purchase coverage from a reputable company. If you never heard of the carrier, and neither did anybody else, it may be a stripped-down discount policy that will provide very little benefit to you. If you are asked to pay a large application fee, it is likely it is one of these types of policies. Avoid them. If the company won’t send you details in writing, that’s a warning that something is not quite right. Checking with your family physician will also help verify the validity of the company. If your doctor doesn’t accept their coverage, pick another company. If there are no hospitals in the local network, unless you live in a rural area, select another carrier.
8. Check your provider network. You may be paying the lowest rate in the state. But if you have to drive 100 miles to be treated, your policy won’t be very valuable to you. Also check availability of other facilities. At least a few of your local hospitals should be included in the Network. If they aren’t, it might be a good idea to consider a different health insurance company. Sometimes, smaller local companies will have very competitive rates. But often, they won’t have any network doctors in your area either.
9. Don’t buy additional riders unless you have carefully reviewed their cost and benefit. Supplemental accident, life, dental, vision and maternity are a few of the most popular add-ons to policies. If they’re not cost-effective for you, then do not add them to your plan. Most riders can be added at a later date so it’s not imperative to add a benefit that may never be used. For example, dental and vision plans can be purchased separately at any time of the year. Since they are not mandated (required), there is no penalty or tax if you don’t obtain coverage.
10. Don’t do it alone! Websites like ours, which provide free quotes and information, are great tools that can only help you. While you buy medical coverage once per year, we help thousands of individuals and families each month. We can help! Use the “Get Free Quotes” space on this page. Our advice is also free and we understand that navigating through all of the Exchange options is very confusing. We help you calculate your federal subsidy and compare your best choices. And most importantly, we review the most recent changes (there are always updates and rate increases/decreases) and discuss how they impact you and your family.
We help consumers purchase reputable plans at the best possible rates. There are never any fees for the assistance we provide and you can always contact us with your health care concerns or questions about your State Exchange. Our goal is to save you money by finding the best available coverage for you.