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Monthly Health Topics

Money Talks: Budget-Savvy Insurance Shopping

By Errol Pierre

The 2015 Open Enrollment period for health insurance through Obamacare began November 15, 2014 and ends February 15, 2015. This is the time when you can enroll in a health plan for 2015 through the New York State of Health (NYSOH): The Official Health Plan Marketplace.

While three months seems like plenty of time to sign up, I recommend enrolling as early in the open enrollment period as you can. It’s important not to wait because there is a delay between the date you sign up and the date your coverage begins. For example, if you want your coverage to begin on January 1, you need to enroll by December 15. If you miss the December 15 deadline, the earliest date you can be covered is February 1. This delay continues into the new year as well; if you enroll on January 16, your insurance won’t start until March 1. Avoid the headache and enroll as soon as you can look at available plans.

When comparing plans, it’s important to pick a plan that fits your needs. While all New York State of Health (NYSOH) plans cover health screenings, office visits, hospital services, and prescription drugs, the plans will differ in the number of doctors included in their networks. Some inexpensive plans keep costs low by offering limited networks, which can make it harder to find a doctor you like who is convenient for you to visit.
Something else to consider is the overall percentage of healthcare costs your plan will cover. Coverage levels are named after metals—Platinum, Gold, Silver, or Bronze. Higher-level plans charge more each month but will pay for a larger share of your overall healthcare costs—90 percent (Platinum), 80 percent (Gold), 70 percent (Silver), and 60 percent (Bronze). Here’s an example of the prices for an individual:

Heathfirst
Platinum Leaf
Premier
Healthfirst
Silver Leaf
Premier
Deductible $0 $2,000
Primary Care
Visit
$15 copay $25 copay
Specialist Visit $35 $50
Maximum Out of
Pocket Cost
$2,000 $5,500
Vision $15 copay $30 copay
Dental $15 copay $30 copay

When assessing which plan is best for you, you need to think about your healthcare needs, including prescription medications. If you are in good health and don’t use much medical care, a less expensive plan may serve you better. If you have health issues that require ongoing care, a Gold or Platinum plan might be a better option. Most plans, like Healthfirst, have representatives who can meet with you to recommend a plan based on your needs and help you figure out if you qualify for financial assistance to lower your monthly payments.

If you’re under age 30, you might also consider a catastrophic plan, like Healthfirst’s Green Leaf Plan. Catastrophic plans protect you from large medical bills in case you have a serious (“catastrophic”) illness, and their great benefit is that they have the lowest monthly payments. Catastrophic plans still provide free wellness visits and health screenings, but you’ll be paying out-of-pocket for other services. Catastrophic plans are only available if you’re under 30 (or meet a few limited exceptions), and they’re a good option if you’re in good health and want to keep your monthly costs low.

Errol Pierre is Assistant Vice President of Product Management at Healthfirst. For more information on healthcare reform, go to www.healthfirst.org.

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