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Health insurance plans have a reputation for being complicated, and for a good reason. The acronyms alone (EOB? EPO? POS?) are enough to make your head spin — or wish for a secret decoder ring.
As an added challenge, most of us aren’t taught the finer points of health insurance before reaching adulthood or entering the workforce. So we figure it out as we go, often learning from our mistakes; one of the best lessons on choosing the right plan is getting locked in with the wrong one.
Fortunately, whether you’re enrolling in health insurance for the first time or need to find a new plan, a little information goes a long way. Read on for a breakdown of the most common mistakes people make when selecting (or making changes to) their health insurance, plus practical tips for finding the right amount of coverage at the right cost.
Don’t pick your plan based solely on the monthly premium
When comparing competing (and often confusing) insurance plan options, it’s tempting to pick the cheapest one and move on. But that decision could come back to haunt you.
“A low monthly premium is appealing, especially if you’re on a budget or think you won’t use your insurance often,” says Matthew Lund, director of health insurance contracting at UW Medicine. “But often what’s lurking behind that low cost is a much higher cost-sharing amount and deductible.”
Translation? If you unexpectedly need care, you could be responsible for paying a large percentage of expensive medical bills.
Many low-premium plans also have narrow networks. This means your choice of doctors, hospitals and other facilities may be smaller, and going out of network can be very costly.
“If flexibility is important to you, then you don’t want to find yourself in a narrow network,” says Lund. “These plans make it cost-prohibitive to go out of network for the second opinion you want or the specialty care you need.”
Do make sure you can access doctors and services that are important to you
Not only do women have unique medical needs, but we want to feel empowered to make our own decisions about our own bodies. For example, if you’re sexually active and want to prevent pregnancy, you’ll need a doctor who can prescribe contraception.
“One of the first things you should do is identify the one or two doctors who are most important to you, such as your primary care doctor or OB-GYN. Then make sure they’re available in the plan you’re considering,” says Michele Fisher, chief contracting and payer relations officer at UW Medicine. “Here in the Pacific Northwest, there are many doctors who can’t provide certain types of birth control, such as IUDs and the Plan B morning-after pill, because they work with faith-based health systems.”
Confirm that your preferred doctor, and the address where you want to see them, are both included in the plan’s network. Some doctors work at more than one location, and although one of their facilities may be in-network, another one might not be.
Another tip? If you think you’ll want or need certain specialty services — such as egg freezing and embryo banking, genetic testing or infertility treatments — check whether your plan covers them before you enroll.
Don’t assume your plan has stayed the same
If you’ve had health insurance for a while, then you’re probably familiar with open enrollment (the time each year when you can change plans). No matter where you get your insurance coverage, taking a few minutes to review your options is time well spent.
“Even if you’re happy with your current employer-sponsored insurance, you shouldn’t automatically roll it over to the next calendar year,” says Lund. “The makeup of a plan’s network, as well as the richness of its benefits, can change from year to year. If you suddenly find yourself in a more restrictive network come Jan. 1, or you realize your favorite doctor is no longer in network, you’re likely stuck with that plan until the next open enrollment period.”
This same advice applies to people who purchase individual plans through Washington Healthplanfinder.
“Look closely at your options before making decisions during open enrollment,” says Fisher. “It’s not uncommon for plans to discontinue a certain product, then auto-enroll you in the next closest option. You might think you have the same coverage because you see the same brand name, but in reality, the plan you’re familiar with no longer exists.”
Do think about your unique risks — and plan for the unexpected
While it’s true that younger, healthy people typically don’t need the same benefits as older adults with chronic health conditions, that doesn’t mean you won’t need medical care. After all, if there’s one thing we learned during the COVID-19 pandemic, it’s that unforeseen illnesses or accidents can happen at any time to anyone.
When comparing plans, think about your daily routine, favorite activities and family health history — and the health risks each may pose. For example:
- Do you drive a long distance to work, even during inclement weather?
- Do you play sports or participate in strenuous fitness activities?
- Is your job considered a high-risk occupation?
- Are you at risk for certain diseases that run in your family?
- Are you planning to expand your family?
Make sure you review each plan’s cost-sharing features. If you enroll in a plan with a high deductible or high out-of-pocket maximum, and you unexpectedly need surgery, hospital care or advanced medical treatment, you could find yourself owing money for bills you can’t afford.
“Health insurance can feel overly complicated, but having a comprehensive plan protects you in so many ways,” says Lund. “By asking yourself a few questions and spending a few minutes comparing your options, you can ensure you and your family have the coverage you need when you need it most.”
