5 Tips To Understanding Your Health Insurance Plan : Making the Right Choice When Selecting Your Plan During Open Enrollment.

On November 10, 2014

affordable care act insuranceOpen enrollment for health insurance with the Affordable Care Act, otherwise known as Obama Care, opened on Saturday, November 15th and runs through February 15th, 2015. Many may be looking to make changes to their current health plans and coverage options. Here are a few things you need to know about your health plan to assist you in making the best insurance coverage choices for you.

  1. Standard Preventive Care Benefits- In 2015 all insurance plans are required to cover a set of preventive services like shots and screening tests at no cost you. All Marketplace plans and many other plans must cover the following without charging you a copayment or coinsurance.

-Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

-Alcohol Misuse screening and counseling

-Aspirin use to prevent cardiovascular disease for men and women of certain ages

-Blood Pressure screening for all adults

-Cholesterol screening for adults of certain ages or at higher risk

-Colorectal Cancer screening for adults over 50

-Depression screening for adults

-Diabetes (Type 2) screening for adults with high blood pressure

-Diet counseling for adults at higher risk for chronic disease

-HIV screening for everyone ages 15 to 65, and other ages at increased risk

-Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:

Hepatitis A

Hepatitis B

Herpes Zoster

Human Papillomavirus

Influenza (Flu Shot)

Measles, Mumps, Rubella



Tetanus, Diphtheria, Pertussis


Obesity screening and counseling for all adults

Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

Syphilis screening for all adults at higher risk

Tobacco Use screening for all adults and cessation interventions for tobacco users

2. It Is Better To Be Insured- Life happens. Insurance can help limit out-of-pocket expenses when stuff happens. Understanding the various plans can assist you in finding the coverage you need. Lower premiums typically mean higher deductibles, and plans are setup with copay or coinsurance options, or a combination thereof. Copays are a set amount paid for a doctor or service provider visit, compared to a percentage payment with coinsurance. It is important to understand your deductible and covered expenses prior to choosing a plan. Making decisions that will help with your coverage needs.

3. Understand Prescription Benefits - Each plan will include a list of covered drugs the policy will pay for. If you or a covered member of your household take specific medications, it is important that you review the medication list prior to choosing a plan. Not reviewing could cost you more later, or require you to switch to a different medication that is covered on the plan. It is also important to look for generic alternatives that may save money.

4. Review Your Provider Network – If you regularly see a physician, you will want to review to ensure he/she and the healthcare facility are in network. Meaning they are covered under your health insurance plan.Visiting an out-of-network physician or facility may result in denied claims or premiums paid not being applied to your maximum out-of-pocket yearly expense. If you find yourself in a position where you have utilized someone out of your network, you can always call to negotiate a lower rate. In-network providers have negotiated a lower rate with the health insurance companies, making out-of-network expenses full price and more costly to you.

5. If You Don’t Know Ask – The Henry J. Kaiser Family Foundation has created a video narrated by former U.S. Senate Majority Leader Bill Frist, that helps you understand premiums, deductibles provider networks, various plans, and prescription drugs. It is vital you understand your premium and what you can or can’t do. For answers talk with your insurance provider, State Insurance Department, or the Consumer Assistance Program. To view the YouToons Health Insurance Explained Video – visit http://kff.org/health-reform/video/health-insurance-explained-youtoons/.

By: Mandy Allfrey


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