Are you ready for election coverage to end? If you’re like me, you’ve had enough mud-throwing TV ads with limited content.

While many ads focus on hot-button or polarizing topics, health insurance is rarely the primary topic in any 30-second spot. No matter what side of the aisle you sit, your well-being and financial security are important and health insurance is a big part of that.

As a 23-year veteran of the health insurance industry, I have had a front-row seat every four years to the impact of presidential elections on the health insurance industry. For those still wanting and expecting your father’s Big Three BlueCross plan, let's dig into what you can expect, how plans have changed, how to cover the big stuff, and how you should shop for and avoid major pitfalls in health insurance.


PPO Plans Moving to Managed Care – Have Options for Out-of-Network Care

On January 1, 2015, the Affordable Care Act (also known as the ACA, Marketplace, or Obamacare) officially started. This forced all CREDITABLE plans to cover pre-existing conditions, preventive care, mental health, maternity and more. As a by-product of this industry change, insurance companies raised premiums at unprecedented levels.

To keep plans affordable, carriers moved to managed care plans (HMOs). These plans have strict networks limiting who you can and cannot see (unless it’s a medical emergency). Very few plans that allow you to go out of network (PPO plans) still exist in the individual insurance space. Most of these remaining PPO plans are non-creditable plans, meaning they do not cover pre-existing conditions, mental health or preventive care.

Because of this, when you shop for a plan, it is essential you not only confirm your current doctors are in the network, but also any facilities you may want to use in the event you experience a rare or catastrophic medical situation. Oftentimes, the elite hospitals across the country are the most expensive hospitals, thus HMO plans will not include them.

What do you do if you cannot find a plan that covers these elite facilities? What options do you have for out-of-network care? You may consider a critical illness plan that will pay you cash if you have an illness. You then can use that money at any hospital or doctor you like. In many instances, these plans are more affordable than you think!


Deductibles Climbing Higher and Higher – Covering the BIG Stuff

Remember the days of $250 deductibles and $5 copays? That was when you could seek medical treatment first and not worry about the cost draining your savings. With typical deductibles now at $5,000, $7,500 or more, how does someone afford coverage when using the plan is so expensive?

My suggestion is to look for a plan with a deductible that is only for “the big stuff.” Plans exist that cover “the small stuff” such as prescriptions, urgent care, doctor visits, etc.

These plans only make you meet your deductible for “the big stuff” (e.g., hospitalizations, surgeries, major tests, etc.). No one wants to have a huge deductible, but we also don’t want to have enormous monthly premiums.

Most people will only need “big stuff” coverage a few times in our lifetime. What you will save in lower monthly premiums will usually outweigh the increased premium cost of a low deductible plan.


Insurance Does Not Always Mean Protection – How to Cover Those Indirect Expenses

The average American has less than one month’s worth of expenses in the bank. If someone has a major illness or injury, causing them to miss time at work, more than 50 percent of Americans will face financial hardship.

Should everyone have health insurance to prevent financial loss? Of course! It’s important to look at the big picture. An essential part of financial protection is to have a policy in place that will pay the indirect medical expenses (lost wages, medical travel, mortgage, insurance premiums) in addition to the direct medical expenses that the health insurance covers (doctors, hospitals, medications).

These secondary plans are a fraction of the costs of the actual medical insurance (in many cases, less than $100 per month) but the impact they have when you have a heart attack, cancer or major injury is immeasurable.


Educate Yourself, Review Your Coverage and Sleep Easy

The last two presidential administrations made significant legislative modifications. If you have not shopped your plan in recent years, you are probably not in the best plan for you. Everyone should review their health insurance plan and current needs every year with an industry expert.

The time to change is November 1 through December 15. Although this six-week period is busy for all of us, your financial protection is worth a review. If you need help, HealthMarkets is a local agency (186 Main St., Belleville), and we will do a free review of your plan. Call (734) 252-0064 if you would like more information.