By Dr. Adam Jonas
Last year, open enrollment in the health benefits Exchanges across the country got a lot of attention. This year’s open enrollment period has been much quieter. But Washington’s Health Plan Finder marketplace is open for business right now through Feb. 15 for open enrollment for 2015 coverage.
If you don’t have access to coverage through your employer and you want to avoid a tax penalty – and significant medical debt or bankruptcy in the event of an illness or injury – now is the time to do your health care homework and get enrolled in a plan.
Most people, especially those who’ve never bought insurance, aren’t experts in how insurance coverage works. The good news: it’s a fairly straightforward transaction.
When you buy your own health insurance, you’ll pay a monthly premium, which is simply the cost for coverage every month. You must pay the premium every month to stay covered, whether or not you use any health care services that month.
If you choose a plan with a deductible, you’ll pay for a certain amount of services yourself each year before your insurance will begin to pay. A $1,000 deductible means you’ll pay for the first $1,000 in medical costs before your insurance begins making payments. But even in plans with deductibles, many preventive services are covered at no cost.
If you choose a plan with “co-insurance,” there will be a set percentage you must pay for certain health services, like 20 percent of the costs of a hospital stay. A “co-pay” is a set dollar amount you’ll pay, like $20 for a visit to a primary care doctor.
It’s that simple. And folks worried about whether they can afford insurance should know that an estimated 80 percent of enrollees who buy through the Exchange for 2015 will receive a subsidy to help pay their monthly premiums, co-pays, or both.
Those who don’t qualify for subsidies should also shop around outside the Exchange and consider buying their coverage directly from an insurance carrier, as not all plans and carriers are included in it.
If you have questions, you can visit the Health Plan Finder website (www.wahealthplanfinder.org), call the Exchange call center (1-855-WAFINDER / 1-855-923-4633), or call any insurer directly to ask about their options. Do your homework and get enrolled. You must buy coverage by Dec. 23 for it to be effective on Jan. 1.
Dr. Adam Jonas practices internal medicine at Group Health’s Bellevue Medical Center and Overlake Hospital Medical Center.
