Both costs and coverage matter when choosing insurance

Both costs and coverage matter when choosing insurance

By: Trudy Lieberman

It’s open enrollment time for medical insurance, and for people shopping the individual insurance market, the choices are as confusing as ever.

Television ads splashing over the airwaves as the midterm elections came to a close didn’t help much. By the end of the campaign, it was hard to find any candidate – Democrat or Republican – who didn’t want to cover people with preexisting health conditions.

The devil was in the details, though, and how politicians suggested people should be covered remained mostly a mystery.

In Missouri, for example, Senator-elect Josh Hawley, as the state’s attorney general, signed onto a Texas lawsuit that would wipe out coverage for preexisting conditions while at the same time running campaign ads saying that he supported “forcing insurance companies to support all preexisting conditions.” How many Missourians picked up on the contradiction?

Besides the muddled campaign messages, big changes in the individual marketplace can easily trip up families searching for a good policy.

The individual mandate – the requirement that nearly everyone have insurance – is gone effective January 2019. That means there are no penalties for not having health insurance.

The Trump administration has also resurrected two kinds of insurance policies that caused consumers lots of problems in the old days: association policies sold by groups that band together to buy insurance, and the so-called short-term policies that are active for only a short time. This year the Trump administration says a short-term policy can last for three years.

The idea behind these two kinds of policies is to make insurance cheaper. In some cases it can be far cheaper than an Affordable Care Act policy sold on your state’s shopping exchange.

There are good reasons why these plans are cheaper than policies complying with the Affordable Care Act, which cover more conditions such as mental health treatment and pregnancy care, plus end restrictions on lifetime coverage.

The ACA-compliant plans’ biggest protection of all may be the right to buy a policy no matter what your existing health condition is, and the ACA has opened the door for millions of Americans to buy health coverage for the first time.

However, that protection so valuable to sick people comes with a trade-off: higher premiums. Since insurers selling in the state exchanges can no longer exclude sick people, they need to compensate for the greater risk people with heart disease, cancer or other major illnesses present by charging higher premiums.

Sellers of association policies can make their offerings very unattractive to sick people by limiting the number of doctors in their networks who treat certain costly diseases like HIV-AIDS, for example. If people with this disease can’t find a physician in the network, they’ll likely pick another plan.

In comparing policies this year, first consider how much you can pay. Remember, the government helps those with incomes below 400 percent of the federal poverty level pay the premiums if they buy a policy in one of the state exchanges.

Next, closely examine the coverage. Some people may find a policy that covers two visits to the doctor is fine, but a person with a chronic condition won’t. Others may find the prescription drug or mental health coverage of an ACA policy is what they need.

Start your search by looking carefully at the offerings on your state exchange. It’s possible that you’ll be able to buy a silver plan that offers more coverage than a bronze policy and costs less this year. You might be asking yourself: Are these “new” offerings better than nothing?

As I’ve said before, it depends on your tolerance for risk. If you’re healthy and willing to gamble you’ll never get sick, then a short-term policy that doesn’t offer comprehensive coverage might work. But if you’re worried about unexpected illness, buy the best policy in your exchange that you can afford.