Ques­tions to ask your­self be­fore choos­ing a health plan

Daily Local News (West Chester, PA) - - FIFTY PLUS - Kath­leen Martin Le­gal Ease

It is open en­roll­ment sea­son for many em­ployer spon­sored plans, for Medi­care (Oc­to­ber 15-De­cem­ber 7) and for the Oba­macare in­surance ex­changes (Novem­ber 1-De­cem­ber 15). This is an op­por­tu­nity to look at your cur­rent med­i­cal in­surance plan and to make changes if ap­pro­pri­ate. Some peo­ple find that their cur­rent plan has been elim­i­nated or that the pre­mium has jumped. Oth­ers have moved to a dif­fer­ent area or had a change in health sta­tus. No mat­ter what the rea­son, Jonnelle Marte for the Washington Post sug­gests that you ask your­self 5 ques­tions be­fore choos­ing a health plan. (https:// www.wash­ing­ton­post. com/nenws/get-there/ wp/2016/11/04/5-ques­tions-to-ask-be­fore-choos­ing-a-health-plan/).

Ac­cord­ing to the ar­ti­cle, ask­ing your­self some ba­sic ques­tions in­crease your chances of choos­ing the right plan for you. One ques­tion to ask is how of­ten do you get sick? If you rarely go to the doc­tor for ill­ness, and have few pre­scrip­tions, you might want to choose a low pre­mium/high de­ductible plan. You may pay in full for pre­scrip­tions and doc­tor vis­its (review the plan care­fully for in­for­ma­tion on whether you will be billed at the ad­justed rate per the in­surance plan or not) un­til you meet the de­ductible thresh­old.

Then full cov­er­age kicks in. Some em­ploy­ers of­fer health sav­ings plans or flex­i­ble spend­ing ac­counts where you can save money pre-tax for health ex­pen­di­tures. On the other hand, if you visit doc­tors of­ten and have reg­u­lar pre­scrip­tions you have filled, you might be bet­ter in a plan that has higher pre­mi­ums and per­haps only a co-pay­ment.

How much cash do you have in the bank? If you choose a high de­ductible/ low pre­mium plan, and you have a tight bud­get, the cost for med­i­cal care might be dif­fi­cult to ab­sorb. How­ever, if you have cash re­serves and do not uti­lize the doc­tor much, you may reap the ben­e­fits of the lower pre­mi­ums. If you think that you might use your health in­surance a fair amount, higher pre­mi­ums might make more sense (if you are hav­ing a baby or treat­ing a chronic con­di­tion). Pay­ing more each month can pre­vent un­ex­pected bills for med­i­cal treat­ment that may make you fall be­hind on other bills.

Will you be able to see your doc­tor? If you have a doc­tor or doc­tor that you know and trust, make sure that any plan you choose will be ac­cepted by your health­care providers. If you go out­side of the net­work of­fered by your new med­i­cal plan, your costs could be much higher than you ex­pected. If you only have oc­ca­sional doc­tor ap­point­ments, you might be able to man­age the in­creased costs, but con­sider how the costs can add up over time. Ad­di­tion­ally, con­sider the flex­i­bil­ity in choos­ing a doc­tor in what­ever plan you choose. For in­stance, HMOs gen­er­ally are less flex­i­ble in choos­ing a physi­cian. You of­ten need re­fer­rals to see spe­cial­ists in such plans.

Will your drugs be cov­ered? Most pre­scrip­tion drug plans have for­mu­la­ries that in­di­cate what drugs are cov­ered and at what level of cov­er­age. Fur­ther­more, high de­ductible plans may not cover pre­scrip­tions un­til the de­ductible is met. Do the math and the re­search to see what is cov­ered of the reg­u­lar pre­scrip­tion med­i­ca­tions that you take.

What can you do to lower costs? Af­ter you de­cide on a plan, see what you can do to re­duce outof-pocket costs. In­ves­ti­gate if you have ac­cess to a health sav­ings ac­count or health re­im­burse­ment ac­count that can be funded with pre-tax dol­lars. You might have ac­cess to a flex­i­ble spend­ing ac­count, also funded with pre-tax dol­lars. Many plans have price com­par­i­son tools that al­low you to choose the least ex­pen­sive place to go for a pro­ce­dure. Telemedicine is also be­com­ing more pop­u­lar, which can be less ex­pen­sive than see­ing the doc­tor in per­son. Mostly is it a mat­ter of do­ing the re­search and weigh­ing your op­tions.

The le­gal ad­vice in this col­umn is gen­eral in na­ture, Con­sult your at­tor­ney for ad­vice to fit your par­tic­u­lar sit­u­a­tion. Kath­leen Martin, Esquire is li­censed to prac­tice in the Com­mon­wealth of Penn­syl­va­nia and is cer­ti­fied as an El­der Law At­tor­ney by the National El­der Law Foun­da­tion as au­tho­rized by the Penn­syl­va­nia Supreme Court. She is a prin­ci­pal of the law firm of O’Donnell, Weiss & Mat­tei, P.C., 41 High Street, Pottstown, and 347 Bridge Street, Phoenixville, 610-3232800, www. owm­law. com. You can reach Mrs. Martin at kmartin@ owm­law.com

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