So you thought your life choices were confusing? Now, they have become much worse as you confront the challenge of our time: picking health insurance on a health care exchange.
I have been discussing this with my family, my friends, and my patients. Everyone is questioning what type of insurance should they pick. And they not only are confused, they also have become angry and distressed. Some even get sick thinking about how to prevent sickness. Is this logical?
And confusion is not dependent on how intelligent a person is. In my experience, the more educated a person, the more possibilities they consider and the more perplexed they become. Often, there is a sense of giving up: It becomes too much to consider, so just avoid the decision and put it off. This is a mistake, since avoiding making a choice can result in having no insurance at all.
One of my relatives described it this way, "You know, I have a college degree, and a post-graduate degree, and years of business experience advising other people, and I just can't figure this out for any of my kids! They each ask me to help them out, and it's beyond me. Why can't they make this easier? And heaven help people who don't know how to make decisions. How do they cope with this messed up, convoluted process and the long, very long waiting times on these websites? If I'm frustrated, just think about people who have less patience!" That's when he was furious and called me for advice. Also, he may have used much more colorful words to describe his experience!
So let me give you six tips based on my experiences dealing with patients who have made wrong choices and then right corrections:
• Always have health insurance. Health insurance policies give you deep discounts in all aspects of medical care, and prevent bankruptcy.
• If money is a real challenge for you, consider a cheaper HMO or ACO policy. If you have sufficient income or if you want as much choice as possible in physicians, specialists and second opinions, choose a PPO. Federal subsidies may make PPO policies affordable even to lower income individuals. If you have little income, you may have to choose a Medicaid program, which is now almost always an HMO healthplan.
• If you have no medical conditions or illnesses, you can consider less expensive bronze or silver plans. Realize these have higher deductibles and visit co-pays, and more limited prescription allowances and formularies of covered drugs. And you will likely feel the pressure to see doctors less often due to cost.
• If you have a medical condition or illness and expect to have more frequent visits with primary care physicians or with specialists, consider choosing a more expensive gold or platinum plan. With lower deductibles and co-pays, there is less reluctance to see doctors when you have symptoms or problems.
• For a more in-depth discussion of differences in insurance types, see Section 4 on "Insuring and Financing your Health Care" in my book Surviving American Medicine.
• To get more personal advice on your own health care insurance needs, and learn about alternatives for getting medical insurance, talk to a health insurance broker (www.NAHU.org or www.AHIA.net ), an ACA health care navigator (go to www.healthcare.gov and look for "Live Chat" or check at your state's own healthcare exchange under navigator), any insurance company advisor, or your Human Resources representative at your workplace.
Making the right choice is important for you to have a sense of confidence in approaching possible medical challenges whether they are anticipated, or entirely unexpected. This advice above will help you, but there are always others to personally aid your decisions. Don't avoid the issues, but confront them now and put the angst behind you. You will be happy you did.
And then, do it again next year when open enrollment allows you to rethink every choice you just made! These are the gifts that health care reforms keep on giving.