As people go to the Health Insurance Marketplace to do their shopping, it’s going to be overwhelming. There are going to be a lot of options. There’s going to be a lot of data to comb through. And it is going to overwhelm a lot of people. I recommend that you make a couple of very simple decisions to help narrow down the plan selection that you want to focus on.
Several different plan structures – there are HMO plans, and there are PPO plans. Those are the two primary dividers. And with an HMO plan, you’ve got access to a specific network of physicians, specialists, medical centers and hospitals. Typically these will be arranged geographically within a county or a number of counties. But they’re going to be a geographic region to which you have access as far as specialists, providers. These are great, especially for people who live in more populous areas. If you have a relationship with a specific doctor, I would encourage you to find out if your doctor participates with a particular HMO. Because you do want to make sure that you have access to who you want to see and who you’re comfortable with.
Now some people prefer a little bit more freedom to go outside of a network. If you’re a traveler, someone who travels for business a lot; or if you just want the freedom to go see a specialist right away for care as opposed to being referred by a general physician, then you may want to consider a PPO. Typically those will allow you to more easily go outside of a network if you’re out of the area in which you live. Or again if you want to just go straight to seek care from a specialist. Let’s say you get an ear infection. Maybe you want to go straight to see an ear, nose and throat specialist, you’ll have the freedom to do that with a PPO.
Another option that people will see is an HSA, or health savings account. These are nice for people who don’t necessarily have a lot of chronic needs. A lot of people who own their own businesses will do an HSA account because it allows you to put money into a specified account, pretax. Now that money is earmarked specifically for use on your medical and prescription expenses. But you can keep that money in that account any year that you don’t use all of those funds. It’s not like a flexible spending account where the money goes away at the end of the year. Your money remains your money. If you don’t spend it all, it rolls over the next year.
Should you be fortunate enough to enjoy good health all the way up until you become eligible for Medicare at 65, that money still remains yours. So you’re not losing anything. Now an HSA is not for everybody. But you may want to take a look at your anticipated finances for the coming year and decide if that’s something else that you’re interested in.
In addition to that, you want to understand yourself. You want to understand your family, and take a real, honest hard look at over the coming year, “What am I anticipating I am going to need?” If I’m someone who regularly requires checkups for a chronic condition, then I want to make sure I’m covered well for doctor visits and testing. If I’m someone who’s taking a medication to manage a chronic condition, I want to check out the prescription benefit on any plan that I might purchase. If I take specialty medications, like an injectable for instance, I want to know how that’s covered on a plan.
So you want to ask questions. Don’t ever be afraid to ask questions. That’s why there are experts available to answer these things and help you make a decision. But above all, make sure you know what services you need to know the most about. And make sure that you know how each option you’re considering is going to cover those things. Because once you make your decision, that’s what you’re going to live with for an entire year. So the more thought you put into it on the front end, the better off you’re going to be.
The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.