Healthcare Plans: Six Things You Need to Consider

By Mark J. Muñoz on November 25, 2015
Categories: TIPS & TRICKS

November is traditionally healthcare insurance month.  This is the month when employees choose whether to select a different healthcare plan or make adjustments to the one they have.

Americans who are covered by the Affordable Care Act, otherwise known as Obamacare, must also decide whether to stick with their current provider or find a different one.

Here are six things that individuals need to know as they contemplate their healthcare choices:

1. When considering healthcare alternatives with your employer, make sure the physicians you see are still participating in your medical plan or potential plans that you are considering. In reviewing choices, are you comfortable being restricted to a specific group of doctors and having medical care authorized by a primary care doctor or medical group? Or would you prefer to pay a higher premium to have direct access to specialists without a medical gatekeeper?

2. If you are covered by the federal or state Affordable Care Act marketplace, you should tell this to your doctors. Some physicians will not accept these federal and state plans.

3. Don’t just look at the premium. You will also want to examine the full cost of the plan. You should look at what range of services is provided and what you pay when you use the services. Some plans, for instance, will provide infertility coverage, chiropractic care and acupuncture and others won’t. You’ll also want to check out what mental health services are covered.

4. Check out coverage for prescription drugs. Copays and coinsurance for medicine will vary by plans. Some plans will have a copay and others will require you to pay the full cost of drugs until you’ve met an annual deductible. Your drug costs can be lower if the medicine is on a plan’s formulary so check that too.

5. Consider establishing a flexible spending account. Some employers offer these accounts as a workplace benefit. These accounts allow workers to direct pre-tax dollars from their paychecks to cover medical expenses.

Because this money isn’t subject to payroll taxes, it can result in substantial tax savings. Traditionally, employees who did not use the money within the calendar year would lose this money. Thanks to the Affordable Care Act, however, individuals can now carry over $500 into the following year.

6. If you are seeking insurance through the Affordable Care Act, you should find out if you qualify for the so-called Advanced Premium Tax Credit. If you already have this tax credit, you need to reapply for it.

If you qualify for a tax credit, you can elect to take your credit when you file your taxes or you can use it through the year by having it reduce your monthly premiums. Having the credit applied to your monthly bill can be a real boon to families who want to reduce their monthly expenses.

Premium Tax Credits are available to individuals and families with incomes between the federal poverty line ($23,550 for a family of four) and 400% of the federal poverty line ($94,000 for a family of four).


Healthcare Plans: Six Things You Need to Consider

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