The United States has the most expensive healthcare in the world. Around 20% of Americans have medical debt, and 62% of bankruptcies can be attributed to medical debt. Yet, 27.6 million Americans of all ages do not have a health insurance plan.
A health insurance plan can safeguard you against medical costs and improve your access to better healthcare facilities. However, finding the right plan could be challenging because several factors need to be considered. Check out 11 blunders you should avoid committing when investing in a health insurance plan.
Not Assessing Your Healthcare Needs
Do not assume you don’t need a health insurance plan because you are hale and hearty. Medical emergencies can strike anytime. Medical bills can be high, and insurance premiums become costlier as you age.
Hence, you should assess all the expected and unexpected costs that you may incur in the future. This will help you search appropriately for a plan with the maximum benefits.
Not Checking with the Employer
48.3% of private sector establishments in the United States offered health insurance to their employees in 2022. The insurance may also cover your dependents. Find out whether your employer insurance in your firm or your spouse’s or parents’ company suffices your individual and family healthcare needs.
If not, you should seek alternative health plans with private insurers or state and federal programs.
Not Researching Health Insurance Marketplaces
Rushing to buy a health insurance plan without adequate research is a big mistake. Do not rely solely on recommendations from family, friends, or colleagues. Gather information on different health insurance plans offered directly by private insurance companies or the government.
You can explore plans available through the Affordable Care Act (ACA)to obtain comprehensive coverage, affordable premiums, and premium tax credits. Log on to healthcare.gov to learn about health insurance plans on the federal marketplace. Many states also have their own websites for health insurance. You can also check whether you and your family members are eligible for Medicare and Medicaid plans.
Review each plan’s terms and conditions, inclusions, and exclusions in detail.
Not Comparing the Cost Components
Remember to evaluate each cost component when you receive insurance quotes for different plans. Compare the quotes for premium, copay, coinsurance, deductibles, upfront costs, and out-of-pocket costs.
For example, a lower premium comes with limited benefits, and you may need to deplete your savings to bear other costs. A higher premium may offer superfluous benefits that you are unlikely to use. Ensure the quote is within your budget, meets your health needs, and offers quality care.
Not Checking for a Summary of Benefits
When you show interest in a health plan, the insurance provider gives you a summary of benefits and coverage. Do not overlook this summary, as it is crucial to choosing the right plan.
Choose a plan that covers all essential benefits, such as hospitalization, emergency services, prescription drugs, laboratory services, ambulance services, outpatient procedures, pregnancy and newborn care, mental health care, rehabilitation therapy, and substance abuse treatment. Check for additional benefits, such as dental or specific disease management coverage.
Not Disclosing Your Medical History
Many health insurance buyers conceal their pre-existing health issues, such as high blood pressure, heart disease, diabetes, anxiety/depression, or stroke, in the medical history details. While doing so may fetch you lower premiums, it can be considered an insurance fraud. It can become a reason for the insurance company to reject your insurance claim.
Not Selecting Enough Coverage
43%of working-age Americans were inadequately insured in 2022. 9% of these people were uninsured, 11% had a coverage gap, and 23% were insured, but their coverage lacked affordable access to healthcare.
Selecting insufficient coverage to pay a lower premium is a poor decision. You may have to pay the expenses out of your pocket when you face a medical emergency.
Not Checking the Provider Networks
Provider networks under a health insurance plan comprise a list of hospitals, physicians, specialists, and pharmacies you can access during a medical crisis. There are four common types of provider network plans: Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), and Point-of-Service (POS).
Please weigh the pros and cons of each of these plans before enrolling.
Not Reviewing the Claim Settlement Process
Nothing can be more distressing than having your claim rejected during a healthcare emergency. According to a survey, nearly six in ten insured American adults experience claims processing hassles, denials, and other issues when using insurance.
Ensure that you inquire about the claim settlement process from the insurance provider before enrolling. You should know about the documents you need to provide, the timeline for a decision on approval/rejection of the claim, and your rights to appeal a denied claim.
Not Making a Note of Open Enrollment Deadlines
Open enrollment refers to a specific period during which you can buy, modify, renew, or cancel your health insurance plan. This period lasts for only a few weeks once a year. Hence, if you miss this window, you must wait for the next one. You may remain uninsured or underinsured during the waiting duration, which could be risky if you need hospitalization.
You may apply for a special enrollment period after the deadline if you have experienced a qualifying life event such as marriage, having a baby, divorce, death in the family, a change in home address, or loss of health insurance through a job.
Not Watching Out for Red Flags
If a health plan looks too good to be true—hefty discounts, cheap premiums, and many benefits—it could be a scam. The Federal Trade Commission (FTC) advises looking for warning signs for fraudulent medical discount plans and researching the legitimacy of the plan before you pay any money for it.