December not only marks the countdown to holiday celebrations — it is also the time of year when many Ohioans are shopping for health insurance for 2016. Several core factors should receive extra attention when evaluating and choosing a health plan. Careful assessment of medical provider networks, cost sharing amounts, and coverage limits and exclusions will help put you on the path to securing the most appropriate coverage for you and your family.
Yes, the task of assessing health insurance plans may seem daunting, ultimately resulting in the temptation to choose an easy selection based solely on premium price. But skipping a comprehensive comparison of available plans could cost you much more in the long run.
The premium amount should just be one of the boxes to check off on your health insurance shopping list to help you find the right plan. I want to emphasize how critical it is to evaluate medical provider networks, cost sharing amounts, and coverage limits and exclusions.
When assessing provider networks, pay close attention to which doctors and hospitals are in network for the specific plans you are considering because many insurance companies use multiple provider networks. In addition, the nature of the provider networks are changing from years past. Some insurance companies still use the large networks that include most providers in the area, while others have reduced – sometimes significantly – the number of providers that participate within the network. If your provider is out-of-network, you could pay significantly more for health care.
Evaluating cost sharing, deductibles, co-insurance and co-payments, which are costs you will pay in addition to the premium, also is essential because they can vary by plan. One plan might have a high monthly premium and a low deductible, while another plan might have a low premium but a higher deductible and/or more out-of-pocket expenses.
Also, be sure to include these following items on your health insurance shopping checklist:
• Check for annual limits and review exclusions and prior authorization requirements in the plan materials.
• Review if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans may not.
• If you take prescription medications, check them against the list of drugs covered by each plan. Many plans use tiers so some prescription medications have higher co-payments than others and the details will vary from plan-to-plan.
• Thoroughly read all of the plan materials. Doing so will tell you what your rights and responsibilities are under each plan.
Finally, I urge you to be thorough and deliberate in your research as you shop for the best health insurance coverage for you and your family. If you have questions along the way, please contact the knowledgeable staff at the Ohio Department of Insurance by calling (800) 686-1526 or by visiting www.insurance.ohio.gov.