BY KEITH GLEASON
Open enrollment is here again. From November
1 – December 15, individuals may sign
up for or change their insurance plans for the
upcoming year. But health insurance can be
confusing, and everyone’s situation is unique.
So how do you determine the best health insurance option for you?
Th e plan that maximizes your coverage for the least amount of
premium, of course. To break this down, the coverage depends on
the metal level (e.g. Bronze, Silver, Gold), network, and carrier, and
the price depends on factors such as your age, income, tobacco use,
and where you live.
Th is process can be overwhelming, confusing, and just plain not
fun. Complicated language and industry jargon – like deductibles,
co-insurance, co-pays, drug tiers, and maximum out of pockets
(MOOP) are what we insurance agents understand. With the following
information – and perhaps the help of a local licensed insurance
agent – fi nding an aff ordable plan that fi ts your needs and budget
may be easier than you think. And you may even fi nd comfort in
having a broker on your side for other individual and family needs,
such as dental, vision, life, disability, long-term care, and more.
All health plans, no matter the level, must provide some coverage
for at least 10 essential benefi ts. Th ey are:
– Outpatient care, including chronic disease management;
– Emergency care;
– Hospitalization;
– Pregnancy and newborn care;
– Mental health and substance abuse services;
– Prescription drugs;
– Rehabilitation services and devices;
– Lab tests;
– Preventive and wellness services;
– Dental and vision care for children.
Th e level of coverage for these services can vary. All plans must
provide consumers with a brief, understandable description of what
they cover and how their plan works. Th e Summary of Benefi ts and
Coverage (SBC) must be posted on the plan’s website. Check out
UNDERSTANDING INSURANCE
A LITTLE KNOWLEDGE CAN GO A
LONG WAY IN DETERMINING WHAT'S BEST
the SBCs for the plans you are considering – this is a good way to
compare plans and benefi ts. Here are some things to consider when
deciding what health insurance plan is best for your needs.
Who will be covered? Some employers off er family plans, but if
yours does not, your spouse will need to enroll in a health plan. If
you already have a plan, call your health insurance company and
ask about adding your spouse and / or children. During the open
enrollment period, you don’t need to have a qualifying event like
marriage, adoption, or childbirth to add a spouse or children, as
long as your plan supports it.
What if my spouse is insured, but I’m not? You can inquire about
becoming a dependent on your spouse’s plan, but some plans don’t
54 CIRCA Magazine | October • November • December 2020 | www.circamagazine.com
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