Purchasing medical coverage on one of the health exchanges is complicated enough. Add a chronic illness to the mix, and it can be downright impossible to choose the right plan. People suffering from chronic illnesses often take multiple medications and have an army of specialists and a preferred physician, all of which has to be consider when choosing a health insurance plan under Obamacare. After all, if you go with the wrong one, you can end up shelling out a lot of money — or worse, not be able to afford care at all.
“With somebody who has a chronic illness, you have to back into the policy that works the best,” says Kevin Luss, owner of The Luss Group, a financial services firm in Southampton, New York. “You have to focus less on the premium because there’s the premise you are going to get significant use out of the plan.”
A Total Cost Analysis Is a Necessity for Chronic Disease Sufferers
Many health care shoppers have been trained to shop on premium, going with the lowest monthly payment and not giving much thought to the deductible they face, the out-of-pocket costs for medication and doctors visits. Not to mention the coinsurance, which is common with many plans these days. That’s a fine strategy for consumers who rarely go to the doctor, aren’t on any maintenance medicine and are in good health. But if you have a chronic disease like diabetes that requires regular prescription drugs, help of specialists and multiple trips to the doctor per year, shopping on premium alone will end up costing you more than having a pricey plan with a higher monthly premium. All of which is why experts say consumers with chronic illnesses have to do a total cost analysis before starting their search for the proper health plan.
“A lot of people who have been focusing only on the premium are finding the coverage isn’t what was expected, with the deductibles and copays being astronomical,” says Douglas Hough, the associate scientist and associate director in the department of health policy and management at Johns Hopkins University in Baltimore. “As a result, people with chronic illness need to consider what the total cost of care is going to be.” According to Hough, an easy way to determine how much care is going to cost you per year is to compile a list of medications and how often you or family members go to the doctor. With that information, consumers can use one of the many Internet tools available to get a ballpark estimate of how much health care will cost per year. Armed with that knowledge, consumers can then start shopping for a plan that meets their criteria. “When you compare by total cost, you might see a plan that has the lowest premium ends up costing you the most,” Hough says. “The deductible may be high, the copay may be high and the payment for drugs may be high.”
Chronic Illnesses Can Be a Family Affair
Often, there’s more than one family member who’s on a maintenance drug, required to see a specialist on a regular basis or otherwise needs more hands-on care than healthy people. After all, according to Candace DeMatteis, policy director for the Partnership to Fight Chronic Disease, 1 in 2 Americans has a chronic condition, with many juggling multiples issues. Because of that, DeMatteis says that when shopping for health insurance, consumers also have to ensure their preferred doctors are part of the plan’s network. Same goes with prescription medication. Consumers have to make sure their drugs are on the health insurer’s formulary, or list of drugs it covers. Finding a plan that includes all the different doctors and medications may be tough, but Luss says the more expensive the plan, the more apt you are to find most of what you’re looking for in terms of doctors and medicines. Luss says health care shoppers should also consider the support services an insurance provider offers for their particular disease. “People don’t take advantage of the tools to manage their disease,” Luss says. “You want to look for a rich plan.”
Cut the Time to Find a Plan by Knowing What You Qualify for
Shopping for health insurance when you have a chronic disease can become very time consuming, since you have to find a plan that has all your doctors and medications you and your family members take. Thankfully, there are ways to narrow down the choices when sifting through all the plans. DeMatteis says consumers who qualify for premium assistance often qualify for out-of-pocket assistance as well — but only if they choose a silver plan. Knowing you qualify for that will limit your choices because your search will be centered only on silver plans, she says. What’s more, DeMatteis says insurance companies that offer different levels of plans only use one network of doctors, so if your doctors aren’t in the bronze plan, then you can assume he or she won’t be in the other plans and can move on to the next insurance provider. Same goes for the medications on the formulary list. If one plan has it, all the plans with that insurer will cover that prescription drug, DeMatteis says: “It’s critically important when choosing health insurance to make sure it is meeting the health and financial needs.”
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How to Get the Best Plan When You Have a Chronic Illness originally appeared on usnews.com
