Figuring out health insurance is not for the faint of heart. Deductibles, copays and premiums – oh my!

Whether you buy health insurance through the marketplace or get it through your employer, deciphering the plans can be overwhelming. Cindy Geaslin, Director of Patient Registration at NorthShore, suggests these tips to make sure you choose the insurance that will best fit your needs:

1. Metal Levels. A premium is the amount that you pay each month for your plan. When you’re wondering about the different types of monthly premiums, think of fine jewelry. The marketplace has five levels of plans: bronze, silver, gold, platinum and catastrophic, all with different deductibles and coverage. Just like jewelry, the more expensive the metal, the more expensive the premium. For example, bronze has the lowest premiums and covers 60 percent of medical costs. The highest premium plan is platinum, but it covers 90 percent of medical costs. Also know that subsidies may be available for patients who select the silver plan. And the catastrophic plan has select criteria, such as individuals under age 30 or who meet specific requirements.
2. Provider List. Most health plans have “in-network” providers. If you visit those doctors and hospitals that are in-network, your out of pocket is less than if you were to go outside the network. If you want to keep your doctor and go to a certain hospital, check to make sure they are on your in-network provider list. Some plans may not have out-of-network benefits. If you choose to go out of network you may be responsible for total cost of care.
3. Think About Your Health. A deductible is the amount you must spend out of pocket annually before your health insurance company starts paying your medical costs. If you have a chronic medical condition - such as diabetes or heart disease - you may want a plan with a lower deductible. You’ll also want lower copayments – the money you typically pay for medical visits at the time of the visit.  The higher premium allows you to save on your out-of-pocket costs with chronic medical conditions.
4. Math Matters. Be sure to understand your deductible; don’t just focus on the monthly premium. For example, if Plan A has the lowest premium at $150 a month with a $3,000 deductible, and Plan B’s premium is $200 a month with a $1,500 deductible; you’re better off with the Plan B if you anticipate needing more than $1,500 in medical care. Your total annual cost for Plan B’s premium and deductible would come to $3,900 - a $900 savings over the “cheaper” plan.
5. Out-of-Pocket Costs. Remember that you also have copayments and coinsurance – the percentage that you pay for with certain medical visits – and the deductible that count as out-of-pocket expenses. Combined, the three components make up your maximum out-of-pocket costs. The maximum out-of-pocket limit for 2018 is $7,350 for a single person and $14,700 for a family policy under the Affordable Care Act.
6. Benefits. Whether you get insurance from the marketplace or your employer, be sure to review the benefits in your plan before seeking services. All plans offered in the marketplace cover the same essential health benefits.
7. The Right Questions. You can call human resources at work or the member services department of your health plan to ask these questions:
   • Can I go to any doctor, hospital, clinic or pharmacy I choose? How much does it cost to go out of network?
   • Are specialists – such as eye doctors and dentists – covered?
   • Are pregnancy, psychiatric care and physical therapy covered? What about home care or nursing home care?
   • What is the most I’ll have to pay out of my own pocket to cover expenses?
   • How are disputes about a bill or service handled?

Navigating insurance can be difficult to manage. Remember to ask questions and find the plan that works best for you.  NorthShore has certified application counselors available to help patients understand their plan. Call 847.570.4202.