Choosing Your Health Insurance Plan

For those who already have health coverage, the first step during open enrollment should be to review your current plan so you can compare it with plans being offered the next calendar year. The following items are important factors to take into consideration:

• Deductibles
• Copays
• Monthly premiums
• Covered services
• Covered facilities and doctors

You should also think about how well your current plan worked for you and your family in the past year.

• Was your deductible too high?
• How much did you pay for an average doctor visit?
• Were you unable to see a SRHS doctor or facility due to them being out of network?
• Were you satisfied with the prescription drug coverage?
• How often did you use your insurance?
• Did your insurance deny claims?

Next, check and see if your current plan is changing for next year and compare it to your other options. Some key things to check might include:

• Are Medical Group of the Carolinas physicians and locations in the plan’s network?
• Are Spartanburg Medical Center campuses, Cherokee Medical Center, Pelham Medical Center, Union Medical Center and Spartanburg Hospital for Restorative in the network?
• Are your prescription drugs covered?
• Are treatments (physical therapy, mental health visits, etc.) covered?

You can find this information on the insurance company’s website or by calling customer service.

Always keep your family’s particular needs in mind when choosing health coverage. For example, when planning for knee replacement surgery you might need to pay close attention to hospital stay cost and physical therapy coverage.

According to Consumer Reports, those with expensive medical conditions might look at plans with a higher premium that covers more, while those who are “generally healthy” might want to buy coverage with a lower premium that requires more out-of-pocket costs for care.

If you have more questions about choosing health coverage, the National Health Council has compiled many helpful sites. 

The Affordable Care Act

The ACA, or “Obamacare,” aims to get more Americans covered and offers a Health Insurance Marketplace (healthcare.gov) where small businesses and individuals can purchase a policy.

• Many people qualify for subsidies that reduce out-of-pocket costs.
• The marketplace offers four levels of coverage - bronze, silver, gold and platinum ‑ determined by how costs are shared. To determine which level fits your needs, go to www.healthcare.gov/choose-a-plan/plans-categories.
• The ACA requires people to have “qualifying health coverage,” and those who don’t have health coverage face a penalty (a fee) when filing taxes.
• You will need your Social Security numbers, income details and last year’s tax documents to sign up.
• For details or help, visit healthcare.gov or call 800-318-2596.

Medicare

Medicare is a health insurance program sponsored by the federal government for people age 65 or older and younger people with certain disabilities. Medicare is divided into four parts A, B, C and D.

• Part A: Covers the cost when you are admitted to a hospital
• Part B: Covers the cost of visiting a physician or other outpatient services
• Part C: Allows you to choose to receive your Medicare benefits in a different way, part C benefits are also called Medicare Advantage plans
• Part D: Helps pay prescription drug costs. To get part D you must enroll in a private drug plan. It is also offered through some Medicare Advantage plans.

Medicare Advantage plans provide an option to receive your Medicare benefits through local or regional private plans. Medicare advantage plans include part A and B, normally referred to a traditional Medicare and may offer additional benefits and/or part D drug coverage.

To learn more about Medicare enrollment visit medicare.gov.

Other resources

• www.usa.gov/finding-health-insurance
• http://doi.sc.gov/638/Health-Insurance
• www.acscan.org
• www.medicare.gov