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How to Choose the Right Healthcare Plan for You

Posted by Bryan Potok, CPO on

Choosing a healthcare plan can be stressful. You do not only have to worry about whether you’d have enough healthcare coverage for the year, but you also need to consider if you can afford the co-pays, monthly premiums, and annual deductibles. And if you’re a prosthetic user, you also need to take your rehabilitative services and prosthetic devices into consideration.

 Tips on choosing the right healthcare plan for you.

Shopping for a healthcare plan is tricky, but it’s even more challenging for those who are not covered by an employer or Medicare. If this is you, keep reading. We’ll help you navigate the marketplace for the right healthcare plan that you can also afford.

Dates to remember

Open enrollment in the Insurance Marketplace and for the federal HealthCare.gov for 2020 coverage runs from November 1 through December 15, 2019. If you were able to sign up for a healthcare plan between these dates, your healthcare coverage would begin on January 1, 2020.

However, if you don’t choose a different plan during open enrollment and your current health insurance covers you until December 31, 2019, your plan will probably be renewed. Best to double-check with your health insurance provider first.

If your circumstances change and your current plan can no longer meet your health needs for the upcoming year, we highly recommend reviewing your options.

If you qualify for Medicare (65 years and older), open enrollment began on October 15 and ends December 7, 2019.  

If you miss the deadline, you may have to wait for next year’s open enrollment period to change your healthcare plan. However, if you get married, have a baby, or lose your health coverage, you may qualify for a special enrollment period. Ask your insurance provider about this. 

Premium cost updates

The average premium for the benchmark healthcare plan on the Affordable Care Act is expected to drop by 4% in 2020. This is good news for anyone who doesn’t qualify for Medicare, Medicaid, or employer coverage.

However, annual premiums for healthcare plans obtained through an employer is expected to increase by 5% from last year. Other things on the rise include other out-of-pocket-expenses, which include deductibles for employer coverage. This is the amount you need to pay before your insurance begins covering most services.  

Consider your health needs

Planning for next year’s health needs can be challenging since you can’t accurately predict the future. However, you can pretty much see what you and your family are going to need by reviewing previous plans.

If you have been using a prosthesis for some time now, you can gauge your future healthcare needs on your health history. But if you’re a new prosthetic user, we recommend talking with your prosthetist or healthcare team so you can get a better idea.

You also need to check if your current primary care doctor and prosthetist are included in the provider network. You can check the insurance company’s list of providers, or you can simply ask your prosthetist if they’re in the network for the upcoming year.

You also need to consider if you have a chronic health condition like diabetes; how many times you’re going to see your prosthetist, physical therapist, and primary care physician; how often you’re going to need routine care; and if you’re taking medications. Once you’ve figured this out, you will have a better idea of which healthcare plan is right for you as well as your family.

Sometimes lower doesn’t mean better

While it can be tempting to choose the plan with the lowest monthly premiums, consider that these plans come with trade-offs. Insurance plans with the lowest premiums tend to have higher deductibles, which means you shell out significant out-of-pocket expenses.

This is where your estimated healthcare will come in. If you expect to have higher medical costs next year, it’s best to go for the plan with a slightly higher premium but has a lower deductible and out-of-pocket expenses. For example, if you’re going to physical therapy and getting a new prosthetic device, a slightly expensive healthcare plan means you'll save money in the long run because of a lower deductible and out-of-pocket expense.   

Save on healthcare

Aside from your health insurance, there are also other things that you can do to save on healthcare. Depending on your family situation and income, you may also qualify for a premium tax credit, Medicaid (for those with lower income), or extra savings on coinsurance, deductibles, and co-payments. You can check for options available to you on HealthCare.gov as well as your state’s marketplace website.

You can also consider getting a Health Savings Account (HSA), which allows you to set aside money on a pre-tax basis to pay for medical expenses. However, you can only do this if you have a healthcare plan with a high deductible.

The best thing about HSAs is that you can use it for things that aren’t usually covered by your health insurance, such as dental braces or prosthetic socks, sheaths, and other amputee supplies on Amputee Store.

  

Navigating healthcare plans can be confusing, so it’s best not to wait at the last minute to send in your application. Give yourself ample time to dissect and compare the different plans so you can choose the right healthcare plan for you. 

Do you have any additional tips? Please don’t hesitate to share them with the rest of the community in the comments section below. 
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<a href="https://amputeestore.com/blogs/amputee-life/how-to-choose-the-right-healthcare-plan-for-you">How to Choose the Right Healthcare Plan for You</a>

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1 comment


  • I’m a double amputee below the knee on my egos a lot the ast sockets I had created sores a lot of them still trying to heal one now the sockets had lumps where the sores r at changed prosthetic wed pick up the Martin Biontic have Humana now 6000 out of pocket ast year now ? That 6000 was half of my total income I need advise help please

    Paul Bernhardt on

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