Consider affordability, simplicity and predictability when choosing health plan

By Sean Jolley

The open enrollment period for selecting a 2020 Affordable Care Act (ACA) health plan is now underway. This year, Utahns have five insurance carriers to choose from, including Molina; SelectHealth; University of Utah Health Plans; Bridge-Span, which is rejoining Utah’s exchange after dropping out in 2015; and Cigna, which is offering ACA plans in the state for the first time.

The open enrollment period runs through Dec. 15.

There’s a lot to think about when shopping for a plan, so be sure to take time to assess what you need and what’s important to you. According to a recent national survey Cigna conducted, for many people it all comes down to three main considerations: affordability, simplicity and predictability.

Affordability

When you think about the price of a plan, be sure to look at more than just the monthly premium. You should also consider your other costs, such as the annual deductible (how much you have to pay for care each year before your plan starts to pay) and the co-insurance percentage (your percentage share of the bill that you pay after reaching your deductible).

   In general, you’ll pay a lower premium when your deductible is higher. You’ll also pay a lower premium if your share of the bill is higher — for example, if your share is 30 percent (plan pays 70 percent) rather than 20 percent (plan pays 80 percent).

Also, be sure to check if you’re eligible for a federal subsidy for your monthly premium. Four out of five consumers who buy their own insurance on the exchange qualify.

Another thing to keep in mind is that most insurance plans provide in-network coverage for basic preventive care services, such as your annual check-up, at no additional cost. For other types of care, such as when you or a family member is sick or has an ongoing medical condition like diabetes, look for plans that offer quality care providers in your local area, as well as low or no-cost benefits such as prescription discounts and health coaching.

Simplicity

You’ll also want to consider how convenient your plan is when you need to access care or get help. For example, does your plan offer a 24-hour health support line or virtual care (telehealth) appointments, at no additional cost? These services can help you maintain health and wellness beyond your basic preventive care screenings.

In the national survey, 87 percent of people said that health insurance plans should make it easy for consumers to talk to a doctor or nurse 24/7 and 70 percent said they would be willing to try a telehealth service that enables them to talk to a doctor over the phone or computer instead of going to the doctor’s office. The response was even higher — 80 percent — among parents of children under age 18.

Predictability

Predictability is connected to both cost and convenience. In the national survey, 90 percent said that knowing where they could find the best price for their prescription drugs would be a real benefit, and nearly half (49 percent) would be interested in a plan that helps them identify how much they would have to pay for care out of their own pocket.

Check if the plan you are considering offers an online tool to help you estimate your costs by procedure (for example, MRI, colonoscopy or knee replacement) and by health- care provider so you can make informed choices and know what to expect. Doing some research in advance can help you avoid surprise bills later.

Here are some important tips as you pick your next ACA provider:

• Take time to plan, assess and understand. Think about what your healthcare needs are and if you are willing to choose a higher deductible in return for a lower monthly premium. Compare plans at healthcare.gov.

• Be sure to sign up for your 2020 health plan by Dec. 15. That’s the last day to enroll in a new plan or change your 2020 coverage.

• Be sure to pay your first premium before Jan. 1, 2020. Your 2020 coverage starts on Jan. 1 only if you have paid your first premium.

Sean Jolley is vice president of sales for Cigna in Utah.