Choosing The Right Health Care Plan

By on August 6, 2014

Choosing a health care plan is more complicated than ever. Here are the top considerations when shopping for a health care plan.

Maybe you’ll be among the many whose companies are phasing out their employer-sponsored insurance plans (29 million lost employer-sponsored coverage between 2000 and 2012.1) or, you may be starting a business and striking out on your own.

You could join the 5.4 million shopping for health care coverage on one of the new health exchanges set up under the Affordable Care Act.2 Or you could count yourself among the 7.8 million people buying new individual coverage directly from an insurance company.3 Whatever path you take, being an educated consumer can make you a better customer. Here some considerations when shopping for coverage:

  • Insurance premiums are only your upfront costs. They may not be the only health care expenses you’ll have. Deductibles, copayments, coinsurance and out-of-pocket limits vary widely from plan to plan. Review the entire costs outlined on the plans since low individual deductibles and copayments may be aligned with high out-of-pocket limits, and vice versa. Different treatment scenarios in the same plan can also have dramatically different costs.
  • From a plan’s perspective, doctors, hospitals and clinics are not all equal. Insurance plans generally have preferred providers. You’ll get the best financial cost structures only if you go to designated practitioners and institutions. If certain providers are important to you, confirm that they participate in the plans you are considering.
  • Review the specialist referral policies and primary care responsibilities. Some plans require referrals from your primary care physician (PCP) before you can see a specialist, and they may have financial incentives for PCPs to limit referrals.4 What’s more, each plan has its own limits for prescription medication, medical appliances and diagnostic tests. Medication and devices that are important to you may not be covered at favorable reimbursement rates; they may even not be covered at all. Diagnostic tests may be limited to those that the plan defines as medically necessary

If you find yourself shopping on a state health care exchange, you’ll find that each plan fits one of five general categories to describe the overall division of costs between you and the plan. Bronze plans pay 60% on average, and you pay about 40%. Silver plans pay 70%, Gold, 80% and Platinum, 90%. So-called Catastrophic plans pay less than 60% of the total average cost of care on average and are available only to young people and those who have a financial hardship exemption.5

As you can see, shopping for health care coverage has become complex. I can help you weigh your options carefully.

Courtesy of: Irene F. Stolarz
Branch Name: Morgan Stanley, Little Falls, NJ
Phone Number: 973-890-3020
Web Address: : www.morganstanleyfa.com/stolarz 

Sources:
1Employer-Sponsored Health Insurance Coverage Continues to Decline in a New Decade, EPI Briefing Paper 353¸ The Economic Policy Institute, Washington, D.C., retrieved 5/21/2014.

http://s4.epi.org/files/2012/bp353-employer-sponsored-health-insurance-coverage.pdf

2New Survey Results Show Significant Decline in the Uninsurance Rate, Press Release, The Robert Wood Johnson Foundation, retrieved 5/21/2014.

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/04/new-survey-results-show-significant-decline-in-uninsurance-rate-.html

3Private Insurance Market Booming, Kaiser Health News, The Kaiser Family Foundation, retrieved 5/21/2014.

http://www.kaiserhealthnews.org/Stories/2014/April/15/private-insurance-market-booming.aspx

4Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws, Governmental Accountability Office Report GAO-12-355, http://www.gao.gov/products/GAO-12-355, retrieved 5/21/2014.
5https://www.healthcare.gov/how-do-i-choose-marketplace-insurance/#part=2

 

If you’d like to learn more, please contact Irene F. Stolarz.
Article by Wealth Management Systems Inc. and provided courtesy of Morgan Stanley Financial Advisor.
The author(s) are not employees of Morgan Stanley Smith Barney LLC (“Morgan Stanley”). The opinions expressed by the authors are solely their own and do not necessarily reflect those of Morgan Stanley. The information and data in the article or publication has been obtained from sources outside of Morgan Stanley and Morgan Stanley makes no representations or guarantees as to the accuracy or completeness of information or data from sources outside of Morgan Stanley. Neither the information provided nor any opinion expressed constitutes a solicitation by Morgan Stanley with respect to the purchase or sale of any security, investment, strategy or product that may be mentioned.
Morgan Stanley Financial Advisor(s) engaged The Post Eagle to feature this article.
Ms. Stolarz may only transact business in states where she is registered or excluded or exempted from registration http://www.morganstanleyfa.com/stolarz/groupdetail.htm Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Ms. Stolarz is not registered or excluded or exempt from registration.
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