By our Smarty friends at Carolinas HealthCare System
We know the health insurance landscape is complex. If your family is not getting insurance through a group or employer plan, you’ll likely be shopping on the federal health insurance marketplace (a resource for individuals and families to shop for and sign up for a health insurance plan).
You have until Jan. 31 to pick a new plan for 2016 or update your previous one. But the process can be confusing to navigate: costs and premiums rise and fall from year to year, insurance companies introduce new plans, and the choices of doctors covered by a plan become more limited.
In most cases, families who signed up for a health insurance plan on the marketplace last year will be automatically signed up for the same plan again – but that may not necessarily be a good thing. Some plans change or stop being offered.
“No one should have to find out in their hour of need that a preferred doctor, hospital or service is not covered in their health insurance plan,” Dr. Ryan Shelton, a primary care physician at Carolinas HealthCare System (CHS), tells us. “We’re encouraging all patients to check their health plan and know which doctors and hospitals are in-network, because it may have changed. We want you and your family to have access to all the components of healthcare you may need in 2016.”
In picking a health plan for 2016, there are three key items we suggest our readers consider:
1. Quality of Health Care
The good news is that now, all private health plans are required to cover the same basic set of benefits, such as maternity and newborn services, emergency care and pediatric care, including dental and vision.
But the quality of care isn’t the same everywhere. Don’t overlook the class of doctors and hospitals included in a health plan, as well as specialty services you may end up needing, such as a children’s hospital or heart care.
“I value the relationships I have with my patients, and I want to ensure I’m able to continue seeing them and managing their health,” Dr. Shelton says. “It’s so important to me that my patients have access to annual exams and referrals to specialists, when needed, so I’m reminding them to choose their health insurance plan carefully, and to make sure my office and services are in-network.”
Bottom line: A quality relationship with a doctor who understands your priorities and health history is often key to ensuring good health – so make sure your preferred doctors and hospitals are in-network in the health plan you are considering. If they’re not, you will likely have to pay more money out of pocket when they get care there.
2. Price vs. Value
For many families, the primary concern in choosing a health plan is price. It makes sense; patients want to keep their premiums and out-of-pocket costs low, so their inclination is to pick the lowest-priced plan on the marketplace.
In reality, the premium is only one of the costs patients pay to get medical care, Dr. Shelton says. “A lot of plans that have lower premiums require you to pay more out-of-pocket or in co-pays or co-insurance when you actually arrive at the doctor’s, so it’s not a trade-off I generally recommend to my patients,” he explains.
(Click here for a glossary of key health insurance terms.)
Bottom line: When choosing a plan, consumers should look at all of the costs that come with it, including any deductibles, co-pays or co-insurance amounts. Understanding all of these costs will provide a better idea of the true value – and any trade-offs – of the health plan.
Most families will access a primary care doctor for annual exams, when they have a cold or to update a prescription – and being able to visit a doctor close to home is important.
“I remind my patients that CHS has the region’s largest primary care network,” Dr. Shelton says. “Some of our practices even have extended hours during the weekdays and Saturday hours. This makes it easy for our patients to schedule exams, appointments and screenings, making time for their health.”
A health insurance plan is even stronger if it provides access to an entire healthcare system, such as CHS. This means that patient records are easily accessible by all locations across the system, whether that’s a primary care office or a pediatric specialist.
Many health insurance plans also have narrow networks, meaning a limited choice of doctors, hospitals and care locations that you and your family can visit. In this case, it’s buyer beware… Narrow networks can be inconvenient for parents who are forced to travel far for a doctor’s appointment, have fewer specialists they can be referred to or lack options for specialty care such as pediatric or neurological treatments.
Understanding which urgent cares and emergency departments are nearby is essential, as well. In addition to its hospitals, CHS has multiple urgent cares as well as freestanding emergency departments in the region.
Bottom line: Choose a health plan that provides easy access and seamless integration among the doctors and services you use most. Two plans Dr. Shelton highly recommends for low costs, convenience and world-class services are Blue Local with CHS from Blue Cross and Blue Shield of NC and Aetna Leap-CHS from Aetna.