Finding a perfect fit
Many options to consider when choosing plan
PICKING A health care plan is rarely a picnic.
Susan Scott, a freelance greeting card and textile designer, has spent hours checking out new plans available through New York State’s health care exchange, comparing co-pays, deductibles and premiums.
But Scott, 59, has found the work worth it. She has honed in on a Fidelis plan for about $390 a month. While it doesn’t include all the doctors or hospitals she would wish for, the premiums are less than half the cost of comparable plans she has bought in the past, and it provides better coverage than a cheaper “catastrophic” plan she has now that protects her only in dire situations.
“I’m so relieved and happy to have these new options,” Scott said. “It’s definitely an improvement for New Yorkers.”
The exchange — NY State of Health — offers one-stop comparison-shopping for people who need to buy their own insurance.
Making the right choices, though, still takes homework.
For freelancers and independent contractors, calculating something basic — how much you make — can be a challenge. It’s key, though, for finding out if you’re eligible for certain cost-cutting programs, said Elisabet h Benjamin, vice president of health initiatives at the Community Service Society of New York.
You can find out if you can get Medicaid — for example, a family of four making less than around $33,000 a year. On the exchange, families making below four times the federal poverty limit — about $94,200 a year for a family of four — can get tax credits that trim the cost of their premiums. Those making less than 2.5% of the limit can get help with cost-sharing, as well.
All of the plans in the exchange must cover certain basic services, but you’ll have to decide among four tiers of coverage — bronze, silver, gold and platinum.
The tiers differ in terms of how much you pay upfront and how much you’ll pay when you get services. Bronze plans have the lowest premiums and the highest costsharing, deductibles and out-of-pocket maximums, while platinum plans are at the opposite end.
While it’s tempting to pay the least each month, consider your costs if you get sick. “Take a look at the deductible and ask yourself, ‘If something happened to me, could I come up with that?’ It doesn’t take much — a fracture or whiplash — to rack up health care bills that are in the thousands of dollars,” said Karen Pollitz, a Kaiser Family Foundation senior fellow.
Premium tax credits can be applied to any tier plan, but those eligible for help with cost-sharing need to choose a silver plan.
Subsidies don’t apply to the catastrophic plans available to people under 30 and certain others.
You’ll want to check if your current doctors accept plans you’re considering, and check what each company charges for any medications you take.
elazarowitz@nydailynews.com