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Wait! 7 questions to ask before you renew your health plan

If you bought an Obamacare health plan in 2014, you must choose whether to renew or shop for a new plan by Dec. 15 2014 in order to have coverage by Jan. 1 2015.

Simply renewing your health insurance plan might be the easiest way to get coverage for next year, but shopping around can benefit your wallet and your health.

Most Americans spend less time studying their health insurance options than they do picking a cellphone plan -- but that's a big mistake, says Roberta Riportella, a professor of community health at Kansas State University in Manhattan, Kan.

About 25 percent more insurers are offering plans in the marketplaces for 2015 compared with this year, says Adam Beck, assistant professor of health insurance at The American College in Bryn Mawr, Pa.

In fact, Beck "window shopped" his state's marketplace to see what would be available to a family in suburban Philadelphia, and he found 64 plans.

Here are seven questions you should ask before making the decision to stick with the same health insurance plan.

1. Do I like my plan?

"If not, why not?" asks California health insurance agent Craig Gussin, who says that's the first question he asks clients.

Look at whether you're happy with the customer service provided by your insurer, Riportella says.

Also, review your claims from the past year and see if you got the care you needed, Beck recommends.

For example, did you skip a trip to the doctor due to a high deductible? If so, you might want to consider a plan with a lower deductible, he says.

2. Are plan costs the same?

Take a look at the premiums and the cost-sharing amounts, such as the deductible and copays or coinsurance, to see if they've changed. If so, do they still fit your budget?

It's easiest to use a health insurance comparison worksheet to compare the costs of your current plan with other options, Riportella says.

3. Is my income changing?

If you get insurance through your state's marketplace, a change in income could change your subsidy eligibility or amount, Gussin says.

A subsidy is a premium tax credit that lowers monthly premiums and is set based on household size and income. For example, a family of four with an income of up to $95,400 should get a subsidy in 2015.

Gussin gives a hypothetical example: A 40-year-old self-employed California business owner made $30,000 in 2014 but plans to work more to double her income in 2015. She can expect to lose her subsidy.

"So, she might want to move to a less expensive plan," he says.

4. Is my doctor still on the plan?

It's not uncommon for a doctor to be an in-network provider on a plan one year but drop out the next, usually due to negotiations over money with the insurer, Gussin says. Call your doctor to verify he or she will be on your plan in the coming year, he recommends.

In 2014, Covered California, California’s state marketplace, allowed consumers to switch plans during the year if they found out their doctor was no longer in network.

However, Gussin says this may not be the case in 2015.  

5. Will my medication be covered?

Maybe you've been taking the same blood pressure medication for 10 years, or you're still working with your doctor to find the right antidepressant. Whatever your situation, make sure any drug you're likely to take in the coming year is covered.

Check your health insurance plan's formulary, which is the list of prescription drugs on the plan, Riportella says. "Print out the formulary and take it to your doctor," she says. And if you need a brand-name drug, make sure it's not just the generic version that's included, Gussin says.

6. Has my health changed?

Have you just been diagnosed with a serious condition like rheumatoid arthritis, diabetes or cancer? A new health issue could be a reason to change your plan, Gussin says.

You might need to start seeing a specialist, and you'll want to make sure your new rheumatologist, endocrinologist or oncologist is on your plan, he says.

Also, you might want to switch to a plan with higher premiums and lower cost sharing, he says. It can be easier to pay an extra $50 a month than to come up with a few thousand dollars to pay a big medical bill because you haven't met your deductible, he says.

7. Will I have an unusually expensive health year?

Maybe you're healthy overall, but you know you're going to need more medical care than usual in 2015, Gussin says.

For example, you're going to have hip surgery, you need physical therapy after an accident, or you just found out you're pregnant, he says.

In that case, you might want to move to a plan with higher premiums that covers more just for the coming year, he says.

Marketplace plans are available in four tiers, also referred to as “metal levels” – from bronze, which covers 60 percent of health care costs on average, to platinum, which covers 90 percent.

Catastrophic plans, which pay less than 60 percent of health care costs, also are available to consumers under 30.

Because of the complexity of health plan shopping, it's a good idea to get help from a broker or agent licensed in health insurance, Beck says.

 

 

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