Shop Carefully for a Health Plan if you are Having a Chronic Medical Condition

Health Plan

Health insurance shopping is not a piece-of-cake, as a lot of thought and consideration is required, no matter whether you are having a plan through your employer, a government-run marketplace of your state, or directly from a health insurance company. The best part is that you can no longer be denied health insurance because of a pre-existing condition, thanks to the affordable care act. However, this doesn’t mean that shopping for health plans becomes easier, and if you have a chronic condition then making a purchasing decision becomes much more difficult.

Around 45% of the population, more than 133 million Americans has at least one ongoing or chronic medical condition like cancer, diabetes, heart disease, or asthma. The health insurance decision remains the same even if your pre-existing condition because while shopping for a health plan like everyone you also look at coverage levels, premiums, deductibles, and out-of-expenses associated with the plan. However, you need to more careful while selecting a health plan simply because you will likely be using more health care than someone healthy.

Discuss with your Doctors

If you are having a chronic medical condition and looking to purchase a health plan, then you should start your health insurance shopping by first discussing it with your health care provider. Before signing up for any plan, talk to your health care provider to discuss your next year’s treatment plan. Whether you will be requiring any surgery or you will need to undergo an expensive medical procedure, or your problem is well managed and under control? You also need to discuss whether you may need some additional prescription refills and periodic checkups or not in the coming year. Though knowing about your exact health condition in the coming year is not possible, but having an idea about these things will help you crunch numbers, and see what options are best for you.

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It is commonly observed that a majority of people buy health plans based on the monthly premiums alone, whereas the fact is that you should buy health plans not solely depending upon the premium amount, but should also consider about the plan’s copays, annual deductible, and out-of-pocket maximum. You should then consider your health conditions and check your next year’s spending that you are expecting to incur on your healthcare. If you will use a lot of healthcare due to your chronic health conditions, then the plan you considered expensive at the time of buying may end up being economical given the way it covers your healthcare needs.

Check the Healthcare Provider Networks and Medications covered under a Plan

If you have any major chronic illness, then while purchasing a health plan you should check the healthcare providers and hospitals included in the plan’s network. Some of the plans provide some coverage for out-of-network providers and some plans don’t provide. Checking whether your doctors or hospitals are in-network or not is important and it becomes more significant if you have a chronic condition. You should remember that health insurers often change their plan networks, so you need to check every year that your doctor is included in your plan. You can even call your doctor’s office and confirm by specifying the exact name of your plan because some doctors may be taking a plan offered by your health insurer but not accepting the plan in which you are enrolled. In case if you are seeing a doctor for your health condition and that doctor will not take your plan next year, then you have to make a big decision. In such a scenario, you either need to change your doctor or you need to change your plan. Besides doctor and hospital, you also need to check whether your medications are covered or not. Most of the plans have their formularies or lists of preferred drugs that they cover at a higher rate. If you have a chronic health condition, then it is more likely that you would be taking medications regularly. So it is important to check the medications covered by your plan.

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Lifestyle and Health Plan’s pre-certification Requirements

If you have a chronic condition and you frequently travel, then you should consider buying an HMO plan because HMOs cover emergency room visits and resulting hospital stays irrespective of the ER location. If you have a PPO or POS plans and you get admitted to the hospital while being out-of-town, then you will be billed for out-of-network follow-up care by the different health care providers who treated you. However, the downside of the HMO’s plans is that these plans have more restrictive formularies. Thus, if you have a chronic condition and require a new prescription, then it may not be covered. Besides, HMOs require you to get pre-certification for treatment or tests otherwise they will not reimburse you. Therefore, you need to weigh the pros and cons of your choice. You should also check whether the plan you are considering to buy offers a disease management program for your chronic condition or not. You should opt for a plan that offers close coordination of care to help you manage your disease better.

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