6 Tips to Make Buying Health Insurance Not Give You a Migraine

More than 8 million people are enrolled in health insurance through the government marketplace, according to the U.S. Department of Health and Human Services. (Alex Williamson/Ikon Images/Corbis)

If you haven’t thought about your health care coverage for 2015, now’s the time. For plans in the government exchange, you’ll need to enroll by Dec. 15 in order for coverage to start Jan. 1. And with a flurry of recent and upcoming changes to plans and regulations, your current plan might no longer be your best option.

“Even if you had coverage this year that you were very happy with, it’s a good idea to go back to the marketplace to see what your options are,” says Rachel Klein, director of organizational strategy for Families USA, a nonprofit consumer health care advocacy group. “In most marketplaces, the plan benefits and the prices have changed a lot.”

If you’re one of the 17 percent of Americans without health insurance, higher penalties might give you additional incentive to enroll this year. In 2015, the fee for being uninsured goes up to 2 percent of your household income, versus 1 percent in 2014. (Some people are exempt from the penalty.)

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But you don’t have to spend hours crunching numbers, cursing at the computer, and suffering through bureaucracy-induced headaches to find the right health insurance for you and your family. Yahoo Health talked with health insurance insiders to learn ways to simplify your search, save you cash, and protect your health in the coming year.

Beware of sticker shock
“A lot of people only look at the monthly premium and forget to look at other costs,” Klein says. “Then when they go to the doctor for the first time that year, the copayments are higher than they expected them to be, or the deductible is much higher.” Think back to the past year: How many prescriptions did you fill monthly? How often did you see the doctor? Choosing a plan with a higher monthly premium might save you money overall by covering more of your costs.

Hunt down this hidden line item
In addition to the premium, copayments, and coinsurance, there’s one more major number to consider: your annual out-of-pocket limit, says Carrie McLean, a health insurance expert with eHealthInsurance.com. If you break your leg or your daughter needs her appendix removed, you’ll probably blow through your deductible and have to start paying for a certain percentage of the charges (called coinsurance). Fortunately, health plans limit the total amount you have to pay in one year. Once you’ve hit that cap, called the annual out-of-pocket limit, health insurance takes care of the rest. The limit can range anywhere from $500 to $10,000 or more, so it’s a good idea to take a look and ask yourself, “In an emergency, would I be able to come up with that?”

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Re-enter your info
The first step everyone should do when searching for insurance is to go to healthcare.gov and enter your information to see if you qualify for financial help paying for insurance, and if so, how much help you’ll get, Klein says. If you don’t take this step, you’ll automatically get the same amount you received last year (if anything). But the changes in the marketplace mean that you could qualify for more assistance, even if your financial status hasn’t changed.

Consider other forms of financial help
If your income is below 250 percent of the federal poverty level ($39,325 for a family of two), you can get extra help with deductibles and copayments, which is called cost-sharing reduction. This is different from the subsidies that help offset the cost of your premium (the amount you pay monthly). “You have to buy a silver plan to get that help, but it makes the cost of getting health care a lot less expensive,” says Klein.

If you love your doc…
Be sure to check that he or she is in your insurance network. “A big mistake that people made last year is they just looked at the price of the plan, and they didn’t check to make sure their doctor accepted that plan,” McLean says. You can use eHealth’s doctor search tool to see all of the different plans your doctor takes. Call the office to confirm before you commit.

Even if you’re sticking with the same insurance plan, it’s a good idea to check with your doctor’s office to make sure they’re accepting it in 2015. “The network can change year to year,” McLean cautions.

Pay your premium early
Your first premium payment is due before your effective date. Wait until the last minute to get it in, McLean says, and you could be on hold for several hours when trying to pay over the phone or talk with customer service. Make sure to schedule the payment with time to spare.

If you’re stuck, a licensed insurance agent can help you run the numbers, McLean suggests. The government’s healthcare.gov website is another good source for information.

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