HEALTH AND WELLNESS

A Clinician’s Advice for Choosing a Health Plan

Every year, the designated open enrollment period for health insurance arrives no matter where you work, and you have the opportunity to choose a health insurance plan that best suits you, your family and your overall health needs. This is a critical decision-making time not just for your finances but for your health. Studies show that if your health insurance covers certain types of care, you are much more likely to access that care—this goes for everything from preventive screenings to mental health services. Choosing a health insurance plan is your only chance to make sure that your specific needs will be covered.

But too often, the process can feel confusing or difficult. One 2017 study found that nearly 50 percent of respondents said that making health insurance decisions is always a very stressful process. If you feel under pressure this year, you’re not alone. Research in 2020 showed that, for half of all workers surveyed, COVID-19 has made the open enrollment process feel “more important this year” than before.

To help guide you in the decision making process this year, we asked Amazon Care clinician and nurse practitioner Amber Boyd, who is married with two children, how she personally researches and chooses a health plan for herself and her family. Amber walked us through how she chooses the best health care plan for her family of four—two of whom are “medically fragile,” with extensive healthcare needs.

“There is no sugar coating the process—insurance options are difficult!” she says. Here’s her personal approach.

Step #1: Get Started By Thinking About the Year Ahead
Amber encourages everyone to take time to write out what you know about your future health care needs, before you start researching plans.

“I recommend starting small. Before reviewing your options, sit down and write out what you think you and your family’s needs will be throughout the year,” she notes. “Will you be getting married? Traveling? Need known medical procedures? Anticipate pregnancy? Once you can lay out the challenges facing you, look for a plan that will best match your needs.”

Step #2: Tally Up Your Out-of-Pocket Costs
When it comes to number crunching, she advises adding up all of your out-of-pocket healthcare costs from the year prior to get a rough estimate of your existing budget. Then, try to project out what you might need in the next year. “I try to look at last year's expenses, relative costs of medications I know my family will continue to need and any upcoming planned procedures or needs. Once I do all of that, I look at the overall out of pocket expenses I will likely have,” she said.

“In my experience, it is the maintenance care of having a medically complex family member that ends up costing the most,” she adds. “I have learned over the years that equipment, medications and day-to-day supplies really can cost my family a lot of money. I try to do my very best in estimating those things.”

Like Amber does, you can count all your medical expenses from the past year to get a sense of what your costs should look like in the year ahead. To plan for new expenses, such as childbirth or a medical procedure you’ve never had before, you can look up price estimates on a site like HealthcareBluebook.com. And for preventive and primary care, start by counting the copays/coinsurance costs that each plan associates with basic preventive care, too—including things like physical exams, eye exams, and dentist appointments.

Step #3: Simplify Available Plans with Pros/Cons Lists
“Even though I am a medical provider, choosing my personal medical plan tends to be complicated,” says Amber. “I spend ample time each year weighing the cost, need and changes to the plans before deciding.”

Part of analyzing each health care plan available and how it would suit her and her family’s needs involves making a “Pros/Cons” list for each plan.

“I find that I best tackle our ever-changing needs by sitting down and doing a cross comparison of the medical plan options to weigh the differences,” she says. “Once I can decipher the various plans’ Pros/Cons, I will then assess the financial aspect.”

Some factors that make it onto her “Pro” and “Con” lists:

  • Overall cost
  • Ability to stay with my provider
  • Medication coverage
  • Need for referrals
  • Out of pocket expenses
  • Co-pay prices.

To assess costs in particular, it’s important to know everything that goes into a plan. The upfront cost of a plan is generally your premium—what you pay out-of-pocket each month. The other key components of a plan that will affect your total cost are:

  • Deductibles—how much you have to pay out of pocket for certain services before your insurance kicks in and can be used at all.
  • Co-pays and co-insurance—set amounts or percentages that you have to pay for each service or prescription, while insurance covers the rest.
  • Out-of-pocket maximum—the most you’ll have to pay out of pocket in a given year.
  • Dental/vision coverage—this is often offered at an extra cost beyond your main insurance premium, with its own deductibles, co-pays, and co-insurance rules.

Finally, Amber notes that you should check in with your current health care providers to make sure they accept, or are “in network” with, your insurance plan. Even if you are sticking with the same plan, doing a thorough analysis of available providers and out-of-pocket costs is important, since plans can change year to year.

Step #4: Use Available Resources to Help
“Utilize online comparison tools and visit your employee benefits or Human Resource group website if you have questions,” Amber says. “Ask the questions! No question is too small or too big!” She adds that you can go directly to the plan provider themselves with questions as well.

Amber also relies on a case manager to help her estimate costs for one of her medically complex family members, and encourages others to do the same: “If you have a case manager involved with your current plan, please talk to that person! You can call and ask if they have case managers available to assist you in your loved one’s care.” Case managers are often nurses whose job it is to optimize the efficiency and coordination of care that the insurance company is covering.

Open Enrollment for Amazon Benefits starts Wednesday, February 10. Interested in learning more about how Amazon Care works with your benefits? Read more here. And if you’re already enrolled, download the Amazon Care app to get started today.

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