By Chandler Gray, as told to Hallie Levine
As a middle school social studies teacher, I help my students build critical thinking and analytical skills every day. But every year, I find that I use these myself to figure out my health insurance plan.
It's quite a process, although I'm one of the lucky ones. I have decent health insurance through my job. I also work in a small school system, where three individuals that I all know personally handle our benefits. When I'm confused or need advice, all I need to do is pick up the phone or send them an email. It can be a lot harder if you have multiple health insurance plans to choose from, and very little or no help to guide you through your options.
Here's my advice for anyone who tries to navigate this system:
Do weigh your options. For years, my wife and I opted for a high-deductible plan with low premiums. It made sense when we were younger, but now that we are in our 50s, we have opted for a more robust plan. Yes, we pay more for monthly premiums. The trade-off is our deductible is lower. It's worth it, because I now see a cardiologist once a year to manage blockages in a couple of my arteries. They are being treated with medication, but I could require a more complicated medical procedure down the line.
Do make sure your loved ones have the right insurance plan. Every year, I have to help my 84-year-old father with his health insurance. Since he is a former educator, he gets health insurance through the Teachers Retirement System of Georgia.
Unlike me, my dad has no technology background. He uses a flip phone and has no internet access at his house, so he can't go online to research plans and enroll himself. He also has hearing loss, so it's hard for him to get anyone on the phone to guide him through the process. This is a man who gets mad and yells at the TV remote. I can't expect him to manage his health insurance by himself.
We do it together once a year, and it's a huge process. Every couple of years, we do a full review of his insurance, to make sure he's on the best plan for him. It's a tedious process. I drive to his house, which is about three hours away, and then we look at all the available plans on my computer.
First, I check all the plans, to find ones that have all his current doctors. After I do that, I calculate out-of-pocket costs, including premiums, estimated copays, and his deductible. It's a headache, but I usually end up saving him an extra $60-$100 a month.
I'm glad I am there to help my father, but I always worry about other elderly individuals who don't have someone to sit down with them to calculate the best health insurance for them. The system shouldn't be so hard to navigate.
Do ask around. At each point in your health insurance process, get advice from other folks. It can be hard to decipher all the jargon in your medical plan. It's especially true if you are a young person who has just begun to pay health insurance on your own.
My advice? Reach out to your employer and ask to be connected with whomever handles insurance. They can get you up to speed within minutes. They may even be able to sit down and calculate overall insurance costs with you. You do want to tap into that knowledge base, to maximize what you pay for.
You should also tap into local contacts if you need help to find an in-network provider, too. When I had my health scare, I didn't have a primary care doctor. I emailed everyone at my school, and within minutes, I had a list of names.
Don't fall into paralysis by analysis. When it comes to health insurance, it's easy to freeze and get stuck. There are so many options that you can get overloaded.
For years, I stuck with the same health insurance plan, because it seemed so overwhelming to look at other options. But if you don't make a lot of money – for example, you just started out in the workforce – you may be able to save hundreds of dollars a year in health care costs if you just sit down and do your homework.
First, figure out what plans have most of your current doctors in their network. Then, sit down and calculate your total yearly costs. That usually includes:
- Your monthly premium (the amount you pay to your plan each month), times 12
- Your deductibles, how much you'll spend for doctor visits, medical procedures, and prescription drugs before your plan kicks in
- Copayments
- Out-of-pocket maximum. That's the most you'll ever have to pay for covered services in a year. (After that, your insurance company covers cost 100%.)
While this whole process seems overwhelming initially, once you sit down and get started, you can do it fairly easily and quickly. Afterward, discuss your options. This year, my wife and I decided on a plan that has a $340 monthly premium for the two of us combined, with a $2,000 in-network deductible.
Don't go it alone. My wife and I sit down every year to discuss together the pros and cons of potential health insurance plans. It helps to have another set of eyes and ears to weigh in. Also, my wife uses insurance too. I want to make sure she's part of the process.
Don't skip health insurance. Trust me, there have been years when I questioned if my family even needed it. My wife is a former Division 1 college athlete, and I routinely run 25-30 miles a week. We're both extremely healthy and rarely, if ever, see doctors.
But it is "insurance" if you do unexpectedly encounter a health issue. That happened to me a few years ago. I suddenly began to have shortness of breath and dizziness. I scrambled to find a primary care provider, who immediately referred me to a cardiologist.
I had to get a cardiac catheterization, a medical procedure where a thin tube is inserted into a blood vessel to check your heart. Since I did have insurance, I saved thousands of dollars in out-of-pocket costs. Yes, I still had to pay around $2,000, as we had chosen the most basic plan with a high deductible. But I shudder to think what the cost would have been if I had to pony up for everything out of pocket.
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SOURCE:
Chandler Gray, Atlanta.
