Open enrollment: Tips on how to find the right health insurance coverage for someone with diabetes

///Open enrollment: Tips on how to find the right health insurance coverage for someone with diabetes
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Diabetes Bites Newsletter

Deductibles, copays and premiums OH MY! Move over Halloween, there is a far more terrifying season OPEN ENROLLMENT SEASON!!

I don’t know about you, but there is no time more fraught with anxiety than the time I sit down to figure out what health insurance plan I should choose! Tax season doesn’t hold a candle to the burning fire of hate that is sparked in my mind by dealing with my health insurance! So I wanted to share something that has reduced my stress load through the year. Health care financial planning!

As with any good tale of overcoming fear I start with a caution. DO NOT DO NOTHING!

Did you know that last year my health insurance company increased the price on its most popular plan, but the lower cost plan actually offered more benefits?! That was because the company want banking on people NOT reading the plan details and just letting the same old plan renew for the following year! What ever you do, don’t just roll over your plan. It’s is well worth taking a few hours to review the details and compare!

Planning keeps the hero alive. We all know that the guy who rushes out to see what went BUMP in the night is the first guy dead in a slasher movie! Planning keeps us alive! The hero keeps resources together, makes a map of the escape route, he plans the best way to make it out alive! The average american household is one hospital stay away from maxing out their debt load, and one major medical need away from foreclosure/eviction. Move over guys in masks, this is scary stuff!!  As people with diabetes our medical care is a huge piece of our financial planning. So, take the time to crunch the numbers! Don’t run in without a plan!

My tips on finding the right health insurance plan during open enrollment:

  1. Make this logical not emotional!
    Looking at a list of premiums and deductibles is overwhelming and the thought of having more money taken out of our paychecks can be really scary! What if I need that money to make ends meet? What if I end up buying coverage I don’t end up using? SO we make decisions based on emotions. WRITE DOWN THE NUMBERS. Now you’re dealing with cold hard facts rather than making a decision from a place of emotion. Numbers on paper make it much easier to be objective.
  2. Know where your money is going.
    Just looking at premiums and deductibles tells you absolutely NOTHING about an insurance plan’s fit for you!! It would be like buying clothes based on the color and number of buttons but never looking at the size!! Are you spending $4800 on premiums (monthly fees to take part in the plan)  but having to meet a $000 deductible(The amount the customer pays before insurance even takes effect), so you end up spending $6000 just on insulin and supplies?! Guess what, you might have the option to sign up for a plan with a $6000 premiums and a $1000 so you only spend $3000 on medication and supplies over the year! The low premium plan ends up costing you $10800 (And good luck if you actually get sick and need care on this plan!) But the higher premium plan ends up costing you $9000 per year!! I could think of a lot of things to do with $1800! Persons with diabetes should  also be wary of 80/20 plans, these are where (After the deductible is met) the plan covers 80% and the customer covers 20%. This seems fine until you find that they are typically very high deductible plans, and that simple blood work can cost upwards of a thousand dollars, and that adds up to hundreds of out of pocket dollars, and 20% of a hospital stay quickly becomes thousands of dollars. Also ask whether there are separate deductibles for medical coverage (Which could include things like insulin pumps, CGMs and supplies) and pharmacy benefits.
  3. Read the FORMULARY.
    Different plans cover different medications at different rates. Read the formulary for the plan and see how much your medications will cost you monthly after your deductible is met. How long will it take you to meet the deductible paying the cash price for your medication? How much will you spend on medications for the entire year on this plan? Now factor that in with your premiums for the year and compare plans.
    I use a chart something like this to figure out which plan will help me save:
Premiums/yeardeductibleMed tiersMonthly med costsmonthly supply costsmonths til deductible metDr. visitsOther
Fill in your infoFill in your infoFill in your infoFill in your infoFill in your infoFill in your infoFill in your infoFill in your info

4. Can you benefit from an HSA?
A health Savings Account (HSA) lets you plan in advance for money you know you will be spending on healthcare. This money is deducted from your pay before taxes so the money is untaxed as long as it is used toward medical care that year. This lets you set aside money to put toward meeting your deductible before taxes.

5. Plan for the big stuff when you can.
Insurance plans also have an out of pocket maximum. If you are in a year where you have large planned expenses such as a new pump, surgery, or even a child being born, you might hit an out of pocket maximum. This is an amount of out of pocket spending, above which the insurance company pays everything. If you KNOW you have a year with some big medical expenditures coming, it might be worth spending a little more on a plan with a lower out of pocket maximum so the insurance company can pick up more of that tab.

6. Make the most of it!
If you’ve hit your deductible for 2018 get on the phone TODAY! Make every specialist, PCP, lab and medical appointment you’ve been putting off! If you’ve been avoiding a doctors visit, let the fact that your insurance company is finally paying their part be an extra motivator to get in there and get it done!

Diabetes is a disease that takes planning. Trying to just bully through and hope it all works out, rarely really works. Our financial health is very similar. A little forward thinking goes a LONG way!

Here at IDS we want to partner with you to maximize your quality of life and reach your diabetes management goals.

Reach out for financial resources to help you improve that quality and reach those goals too! Healthcare.gov has a tool to direct you to your state’s health insurance marketplace. Once there you can find local resources to help guide you in finding the plan that is the best fit for you. (remember to bring a list of your medications and last year’s medical expenses to have the best projected costs for the coming year)

Remember, Open enrollment ends December 15th.

Whatever you do, DON’T DO NOTHING!

Back to November 2018 Newsletter
By |2018-11-14T17:14:35+00:00November 14th, 2018|Diabetes Bites, November 2018 Newsletter|0 Comments

About the Author:

Integrated Diabetes Services is the worldwide leader in one-on-one consulting for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and the internet for children and adults.

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