Science has proved, no kidding around: Picking health insurance is extremely hard.
Its open enrollment time to pick next years insurance for folks who buy it on their own and for many of us in our jobs. Lots of us arent sure we know how to pick, and research shows: Were not wrong.
A group of economists found that among the plans in front of them.
And its not just average people who have trouble. One of the economists who did that research of Carnegie-Mellon University told me he was personally dreading the process of helping his adult son pick a plan.
I have no confidence that Im going to make the right decision, he said.
So, its not just you.
Most of us, Loewenstein and his colleagues found, have two main problems: We dont understand all the terms, and we have a hard time doing the math.
The good news is, you can avoid some of the worst mistakes. That can mean saving thousands, or even tens of thousands of dollars.
Heres what youre aiming for.
Set Realistic Goals
Youve seen the stats, like how , and youve seen the horror stories, like the guy whose first month of dialysis .
The goal in my family is simple: Avoid disaster.
That may mean paying a little more every month. A health insurance payment the monthly premium is very annoying for most of us, especially since we often still have to shell out to see a doctor, even with insurance.
But getting that monthly payment as close to zero as possible? Probably not your best move. Not if it puts you at risk of a horror story you could avoid.
So: Be very careful with plans that dont comply with Obamacare rules. Theyre sometimes marketed as Trumpcare and although they do tend to have lower premiums, they could leave you vulnerable in unexpected ways.
Just ask the woman in Philadelphia who had her foot amputated.
Understand The Terms
Quick: Whats a deductible? Whats a copay? What is coinsurance? What does out-of-network mean? What does OPX stand for?
And those are just the basics. If youve got them down cold, you can skip to the next section, but otherwise heres a quick rundown:
- The deductible is how much you shell out before your insurance covers much of anything. The amount can be absurdly high. If your plan has a $7,000 deductible, ask yourself, Where would I get hold of seven grand?
- Copay is how much you pay for an office visit with a doctor. Usually a flat amount: $20 or $30 or more.
- Coinsurance is your share of other medical expenses stuff that can get pricey, like a hospital stay. Usually expressed as a percentage: 10%, 20%, etc. (Of course, serious medical stuff gets so expensive super quickly, so 10% of a LOT is a lot.)
- The network is the set of providers doctors, hospitals, clinics that accept your insurance. Anybody who doesnt take your insurance may be able to charge you whatever they want.
- OPX stands for out-of-pocket maximum, and its a key number: It puts a cap on how much you could pay (beyond your premium) in a given year.
If you could use more detail, here are some resources:
- Smart and well-organized: The great reporter Sarah Kliff, formerly of Vox now with the New York Times, offers .
- Longer, more fun, also great: An Arm and a Leg podcast listener Anna Jo Beck sent in a self-published. Friendly, thoughtful, and sprinkled with lovingly captioned pictures of stuff like toddlers, kittens and newlyweds which Beck describes as moments of cute, heartwarming distraction to keep you from totally wanting to give up hope.
- Less warm and fuzzy, but very straightforward: This from Reddits personal-finance community.
Do The Math And The Research
For the math, youre going to want to make a spreadsheet. Maybe open yourself a beer first.
To evaluate an insurance plan, youre solving for two things:
1. What does this plan cost me in a normal year?
If youre superhealthy, maybe that means you dont go to the doctor at all. If youve got some conditions that mean you know youll need a provider, or youre going to need access to meds, figure out what those copays and coinsurance fees might add up to.
2. How much might this plan protect me and how much would I still have to pay if, God forbid, I got hit by a bus or something?
Thats really what insurance is for, and you want to know the answer to this one. Its usually the same as the answer to Whats my out-of-pocket maximum? assuming youve done the research.
The research? This is where you study the network.
This step is especially important if there are things you know you will or could need next year: Might you or your partner get pregnant? Have you reached the age where docs say you should get a colonoscopy? Is there a funny rash youre starting to worry about?
You get the idea.
If so, definitely make sure youre OK with whichever providers are in the network for a given plan.
Because remember that key term, out-of-pocket maximum? Well, in a lot of plans including everything on the Obamacare exchanges this threshold applies only for in-network providers.
With out-of-network providers, not only are they free to charge whatever they want, your insurance is not there to put any limits on what you might have to pay.
For details about making your spreadsheet: Check out this which is illustrated with a photo of him working his spreadsheet, beer close at hand.
About the research: Its not easy, especially if youre going to the hospital for something like surgery or childbirth. A reporter from Bloomberg who writes about health care recently asking for advice.
Get Help, The Best You Can Find
Heres why my economist source was dreading this process. Getting to the bottom line taxes the average persons spreadsheet mojo.
I thought I could figure it out on my own. When I said that to Lynn Quincy, who runs the nonprofit Health Care Value Hub, she laughed.
Your plan could have different deductibles, she said. It could have a general deductible, it could have a pharmaceutical deductible, it could have a hospital deductible.
She was basically saying, Hows your spreadsheet looking now, smart guy?
Of course, the answer was: Looking pretty sad.
For instance, heres part of an actual quote my insurance agent sent this fall: $200 IP $150 OP
I was, like: What do IP and OP even stand for? Just getting the answer to that required a couple of tries-and-misses with Google on my part and I report on this stuff full time. (Answer: inpatient and outpatient. But even now that Ive got that answer how could those numbers affect my bottom line?)
There are automated services that can help basically, databases that do the math for you but we dont all have access to them. Some employers offer this kind of thing as a benefit.
Check with your HR department, and if its an option, jump on it. And if it isnt, well: Ask your HR folks all the best questions you can. And ask if theyll consider adding a service like that next year.
In some states, the Obamacare exchanges offer a similar service, developed by a nonprofit called Consumers Checkbook. Heres the list of .
For the rest of us, heres a whose job it is to explain this stuff. Note that youll find two types of folks listed:
- Assisters, who can help you navigate the Obamacare marketplace or see if you qualify for programs like Medicaid. Theyre obligated to be on your side, paid by government grants.
- Agents/brokers can also help you navigate but theyre generally paid by insurance companies. And not all states require them to act in your best interest.
OK, there it is and, of course, its not entirely pretty.
Just remember: Its not just you.
And this: This is not an SAT question. Theres no one right answer.
Especially: Its not realistic and probably not a good idea to shoot for a game plan where you end next year having spent the absolute least amount of money possible on health care and insurance. Life is kind of a crapshoot that way.
But with a little patience and maybe a stiff drink you can reduce the risk that youll go broke. And thats worth doing.
Dan Weissmann is the host of , a podcast about the cost of health care, now in its third season. It is co-produced by Kaiser Health News.
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