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There’s a flood of stories around Medicare and Affordable Care Act open enrollment this time of year, but surprisingly little attention is paid to the mistakes that groups and individuals make when selecting a new healthcare plan — mistakes which result in higher costs and limited access. A one-size-fits-all approach ignores important differences in the unique needs of large groups of consumers, including women, underrepresented minorities, low-income individuals, and people who live in rural areas.
Picking the right plan is hard. Extensive research conducted by eHealth shows that out-of-pocket costs for medical care is the single-biggest concern of consumers, and 69% say they’ve had a surprise medical bill in the past. But finding a plan that fits your needs can really pay off: another eHealth report shows that Medicare beneficiaries can save an average of $762 per year by optimizing coverage based on their prescription drug needs.
To help understand a broader set of consumer needs, eHealth turned to its Public Policy Advisory Committee, a uniquely qualified group of former governors, state health administrators, and a former US Surgeon General. The committee advises eHealth on a wide range of topics from state and federal regulation, to addressing racial inequities in the American healthcare system.
Committee members were asked to identify common missteps that consumers make when choosing a plan. Their answers provide a practical list of tips and watch-outs for families and Medicare beneficiaries shopping for healthcare coverage during this year’s open enrollment season.
Dr. Jerome Adams, Former US Surgeon General:
One common mistake is choosing the plan that seems to have the least upfront or out-of-pocket expenses. Though not universally true, in most instances you do in fact get what you pay for. And when people choose what appears to be the cheapest option, they are often disappointed on the back-end when they can’t get the services they need.
Avoid choosing a plan without assessing whether the providers or facilities you currently use (or could most easily access and would prefer to use if needed) are part of the network. Having a plan means nothing if you can’t get the care you desire or need.
Don’t select drug coverage that doesn’t adequately cover the medications you are on. Different drug coverage plans use different formularies, and if you don’t choose the right one, you could end up with significant out-of-pocket expenses, or you could end up not being able to afford your medications. As BIPOC (Black and Indiginous People of Color) are, in general, more likely to have chronic diseases requiring regular medication, they are disproportionately impacted by this common error.
Avoid enrolling late and not understanding the penalties. Medicare has specific enrollment rules, deadlines, and penalties that can last the rest of your life if you enroll late. Far too often, BIPOC enroll late due to lack of understanding about the enrollment process, and are subjected to these penalties.
Steve Beshear, Former Kentucky Governor:
I believe some people living on a modest income choose the plan with the lowest premiums even when that may not offer the best overall value for them. Consumers need to study and understand all the costs, including drug pricing and the cost of specialists who can attend to their specific needs.
People living in rural areas need to make sure that the plan they choose offers access to care in the area where they live. Avoid policies that require long travel times to find doctors and facilities in your plan.
Bobby Jindal, Former Louisiana Governor:
Rather than rolling-over last year’s coverage, re-evaluate your choices to reflect changes in your personal circumstances and healthcare needs.
Also, rather than choosing a plan based on a “brand name” or advertising, you should study the details on provider networks, cost sharing, and disease management details.
Susan Kennedy, Former Director, California Health Benefits Exchange:
Women need to make sure the doctors they trust are in network before they select a plan – particularly women’s and family health specialists: OBGyn – Women physicians, pediatricians.
Avoid choosing a plan based on lowest premium rather than the strength of the physician network – HMO versus PPO – particularly as they age and need specialists (dermatology, orthopaedics, pain management, nutrition/wellness).
Women often stick with a primary care physician that treats their family rather than choosing a primary care physician that specializes in women’s health – menopause, mental health, nutrition, prenatal and postnatal care.
Mental health, mental health, mental health – Choose a plan with access to robust mental health providers and services.
Dr. Woody Myers, Former Indiana and New York City Health Commissioner:
Far too often health plan choices are made by simply asking relatives or neighbors, or church members what plans they may have chosen instead of doing a bit of easy homework.
There are both computer-based tools and live (friendly) human consultants who can help guide you to a better decision based on who your doctors are today, what medications you take, and the healthcare services you (not your neighbor!) may need.
And today there are many new, high-quality health plan choices that may not be well known by your friends or neighbors. So, it is important to get up-to-date information and to make a decision that is best suited for you and your own personal healthcare needs. When computer access is limited or when one is not as familiar with technology (as is the case for many underserved patients) it is easy to be intimidated and make a poor choice.
Fortunately, today it is easy to get help from people who know your language, are understanding of your circumstances, and who are eager to help (and will not be in a “hurry” and try to push you in a direction you may not wish to go).
Get the help you need from people who know how important this decision can be for you and your family.
The take-away from eHealth’s five advisors — governors, program administrators, and a US surgeon general — is that consumers should avoid one-size-fits-all healthcare plans.
- Understand the unique needs that may apply to your gender and ethnicity.
- Rather than simply rolling over last year’s coverage, take time to recognize how circumstances may have changed and find a plan that fits your current needs.
- Recognize the distance you’ll need to travel to access your doctors and facilities.
- Beware of plans with modest premiums but costly co-pays and drug prices.
Finally, do your research and consider working with a licensed agent or online broker like eHealth to help you assess your needs and find the right plan.