When choosing a plan it is best to first know what you want in your healthcare. I obviously advocate for preventative medicine, acupuncture, and chiropractic care.
Health Insurance 2018: What you need to know
It’s that time of year again. Signing up for health insurance. If you do not get health insurance from your employer this post is really relevant to you.
With all the new changes in insurance coverage; it can often be quite confusing for not only choosing a plan but know what exactly your coverage is.
The reason why I am taking time to write this article is that as a healthcare provider, health insurance is the #1 reason why people do not come get care, get frustrated that their insurance is “not paying”, or that they actually do not have alternative health coverage, to begin with.
I am going to try and make this as simple as possible but do know this is just basic overview. I suggest talking with a licensed health insurance agent to further the conversation and assist you with choosing a plan that suits your needs.
Where you buy your individual health plan:
Individuals can buy their health plans either on the exchange or directly from the insurance company. The exchange is an online portal containing information, such as WA Health Plan Finder, where you have plan choices and enrollment capability for health insurance. The WA Health Plan Finder is public and is sponsored and run by a government entity, such as healthcare.gov. This is compared to a private exchange which is sponsored and run by a private entity or business, such as an insurance agent or directly from the insurance company.
When do you need to buy your plan?
(directly from www.insurance.wa.gov)
“If you buy through the Exchange, Washington Healthplanfinder, open enrollment is Nov. 1, 2017 – Jan. 15, 2018. If you want coverage to start Jan. 1, 2018, you must enroll by Dec. 15. If you wait to enroll until Jan. 15, your coverage will not start until Feb. 1. Remember, premium and cost-sharing subsidies are only available through the Exchange. You can buy a plan through the Exchange even if you don’t qualify for premium and cost-sharing subsidies.
If you buy directly from an insurance company (outside of Washington Healthplanfinder), open enrollment occurs Nov. 1 – Dec. 15, 2017 for coverage to start Jan. 1, 2018.”
What is your monthly premium?
A premium is a monthly amount you pay to keep your coverage in effect. The amount of the monthly premium is determined by many factors such as the risk of needing health coverage, our current health status, your age, and your lifestyle.
Is there a deductible?
A deductible is the amount of money you pay before your insurance starts to cover services in the plan. It can range from $100-$10,000, depending on the plan. Most providers require you pay them at time of service then claims can be billed to your insurance to apply towards your deductible.
When choosing a plan it is best to first know what you want in your healthcare. I obviously advocate for preventative medicine, acupuncture, and chiropractic care. If you are looking for a particular provider and/or coverage for alternative medicine make sure you choose a plan that covers those specialties. But do know that just because your insurance “covers” those services does not actually mean they will cover them. This is often the case with plans with high deductibles,
Do you want or have alternative medicine care?
Surprisingly, this can be a little harder to find out. The real kicker? If you want to search for provider specialty on the WA state healthplan finder, neither acupuncture or natural medicine are listed as choices! You will need to just put in the name of the clinic or provider into search.
Most Individual state plans have at least 12 acupuncture visits per year. Some Regence plans require pre-authorization for care which creates more paperwork and time for the provider to approve visits for the patient. The frustrating part is that even though the patient is paying a monthly premium for their “12 visits”, the insurance company can still deny covering those visits. This creates a discontinuity of care for the patient.
My two-cents: Make 2018 your year, preventative HEALTH care should be your goal. If you know you want to see alternative health providers, maybe an emergency coverage plan with a high deductible is what you need. This is where consulting with an insurance agent can come in real handy. Do know that you can see an in OR out of network provider while trying to reach your deductible and have the claims apply toward your deductible?
I hope this helps to clarify some insurance and health plan mystery.
Check out these websites for more information:
On vs. Off the Exchange: https://www.ixshealth.com/exchange-vs-exchange
Please share this article!
Dr. Ellie Heintze, ND, LAc
- Master’s Degree in Acupuncture
- Doctorate in Naturopathic Medicine
- Master’s Degree in Chemistry
Northern Arizona University
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